Healthcare Provider Details

I. General information

NPI: 1275160566
Provider Name (Legal Business Name): JERISE ATOCK AGHA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 PENNINGTON ST STE 100
MIDDLETOWN DE
19709-1026
US

IV. Provider business mailing address

111 TUSCANY DR
MIDDLETOWN DE
19709-7855
US

V. Phone/Fax

Practice location:
  • Phone: 302-203-7113
  • Fax:
Mailing address:
  • Phone: 302-373-6887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAC005200
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberLP-0000365
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number845356
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: