Healthcare Provider Details

I. General information

NPI: 1821021510
Provider Name (Legal Business Name): DELPHINE A TIERNEY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S TAMIAMI TR
SARASOTA FL
34239
US

IV. Provider business mailing address

1700 S TAMIAMI TR
SARASOTA FL
34239
US

V. Phone/Fax

Practice location:
  • Phone: 941-917-8889
  • Fax: 941-917-7193
Mailing address:
  • Phone: 941-917-7359
  • Fax: 941-917-7193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1855492
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: