Basic Information
| Provider Information | |||||||||
| NPI: | 1407360753 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NACINO | ||||||||
| FirstName: | CHERRY | ||||||||
| MiddleName: | PABLO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16 CHESTERFIELD CT | ||||||||
| Address2: | |||||||||
| City: | FLEMINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088223524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9087272617 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2100 WESCOTT DR | ||||||||
| Address2: | |||||||||
| City: | FLEMINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088224603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9087886474 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2017 | ||||||||
| LastUpdateDate: | 05/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 26NJ00760400 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.