Jacqueline Canilao, PMHNP
Nurse Practitioner, Psych/Mental Health in Marlton, NJ. Individual provider (NPI-1).
Details
- NPI
- 1194532119
- Entity type
- Individual (NPI-1)
- Name
- Jacqueline Canilao
- Credential
- PMHNP
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Dec 12, 2024
- Certification date
- Feb 5, 2025
- Last updated
- Feb 5, 2025
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - NURSE PRACTITIONER
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice No
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LP0808X | Nurse Practitioner, Psych/Mental Health | 26NJ15228900 | NJ | Yes |
| 363LP0808X | Nurse Practitioner, Psych/Mental Health | 26NR15228900 | NJ |
Practice location
141 Route 70 E Ste BMarlton, NJ 08053-1855
Phone 856-596-9057 · Fax 856-596-0837
Mailing address
301 Lippincott Dr Ste 410Marlton, NJ 08053-4197
Phone 856-596-9057 · Fax 856-596-0837
Other practice locations
Moorestown, NJ 08057-3132
Phone 856-235-4656 · Fax 856-235-4786
Sewell, NJ 08080-4009
Phone 856-341-8390 · Fax 856-341-8131
Marlton, NJ 08053-2008
Phone 856-278-1527
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 108 Psychiatric/Mental Health Nurse Practitioner providers in Marlton · All 2,303 providers in Marlton
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