1578194015 NPI number — JACOB D. ROWLAND DNP, APN, FNP-BC

Table of content: JACOB D. ROWLAND DNP, APN, FNP-BC (NPI 1578194015)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578194015 NPI number — JACOB D. ROWLAND DNP, APN, FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROWLAND
Provider First Name:
JACOB
Provider Middle Name:
D.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DNP, APN, FNP-BC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578194015
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1407A YARMOUTH LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT LAUREL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08054-6254
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-668-7792
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2222 NJ-33
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
HAMILTON TOWNSHIP
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08690
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-890-4100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/03/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WC0200X , with the licence number:  26NR19380500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 26NJ01063600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1578194015 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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