Individual
MRS. JACQUELINE MARIE IANNACONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP-BC, CARN
Contact information
Practice address
2640 HIGHWAY 70 BLDG 7A, MANASQUAN, NJ 08736-2609
(347) 302-3514
Mailing address
382 ATLANTIS AVE, MANAHAWKIN, NJ 08050-2068
(347) 302-3514
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
26NJ01352900
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26NJ01352900
ADVANCED PRACTICE NURSE - RESIDENT
NJ
Enumeration date
08/15/2022
Last updated
08/01/2024
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