Provider Demographics
NPI:1053355768
Name:SHORROCK, PATRICIA ANN (RN,APN,C)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:SHORROCK
Suffix:
Gender:F
Credentials:RN,APN,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 SPRINGBROOK CT
Mailing Address - Street 2:
Mailing Address - City:WHIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07981-1428
Mailing Address - Country:US
Mailing Address - Phone:973-739-9187
Mailing Address - Fax:973-736-3733
Practice Address - Street 1:101 OLD SHORT HILLS RD
Practice Address - Street 2:SUITE 211
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1000
Practice Address - Country:US
Practice Address - Phone:973-736-4430
Practice Address - Fax:973-736-3733
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNN81146363LA2200X
NJ26NO08114600363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ006378CUCMedicare ID - Type Unspecified
NJS49097Medicare UPIN