Healthcare Provider Details

I. General information

NPI: 1053530212
Provider Name (Legal Business Name): DEBRA HARRISON C.P.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBRA TILGHMAN CPNP

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E CARROLL ST PEDIATRIC SPECIALTY SERVICES
SALISBURY MD
21801-5422
US

IV. Provider business mailing address

3286 REDDEN FERRY RD
EDEN MD
21822-2229
US

V. Phone/Fax

Practice location:
  • Phone: 410-543-7729
  • Fax: 410-543-7586
Mailing address:
  • Phone: 410-677-0666
  • Fax: 410-677-0667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR078461
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: