Provider Demographics
NPI:1053787036
Name:ENRIQUE, JENNIFER (APN-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ENRIQUE
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 BROAD STREET
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013
Mailing Address - Country:US
Mailing Address - Phone:973-221-3122
Mailing Address - Fax:973-710-0620
Practice Address - Street 1:716 BROAD ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-1645
Practice Address - Country:US
Practice Address - Phone:973-221-3122
Practice Address - Fax:973-710-0620
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00581400363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health