Healthcare Provider Details

I. General information

NPI: 1861273476
Provider Name (Legal Business Name): TD ADVANCED PRACTICE PROVIDER SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2023
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 OKLAHOMA AVE
WILMINGTON DE
19803-3236
US

IV. Provider business mailing address

102 OKLAHOMA AVE
WILMINGTON DE
19803-3236
US

V. Phone/Fax

Practice location:
  • Phone: 856-340-8466
  • Fax:
Mailing address:
  • Phone: 856-340-8466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TAMICA NICHOLE D'AGUIAR
Title or Position: MANAGER
Credential: NP
Phone: 856-340-8466