Healthcare Provider Details

I. General information

NPI: 1548074693
Provider Name (Legal Business Name): TRICIA NICOLE HARVEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

774 CHRISTIANA RD
NEWARK DE
19713-4236
US

IV. Provider business mailing address

3200 CARILLON DR
WILMINGTON DE
19808-2412
US

V. Phone/Fax

Practice location:
  • Phone: 302-444-8156
  • Fax:
Mailing address:
  • Phone: 302-397-1036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0013067
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: