Provider Demographics
NPI:1548349145
Name:CANTERINO, PAULA (ACNP, AOCNP)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:CANTERINO
Suffix:
Gender:F
Credentials:ACNP, AOCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-1147
Mailing Address - Country:US
Mailing Address - Phone:732-528-0760
Mailing Address - Fax:732-528-0764
Practice Address - Street 1:1707 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1147
Practice Address - Country:US
Practice Address - Phone:732-528-0760
Practice Address - Fax:732-528-0764
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00019000363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P71563Medicare UPIN
063942Q4JMedicare ID - Type Unspecified