Healthcare Provider Details

I. General information

NPI: 1891062576
Provider Name (Legal Business Name): TANNEIL L DAVIS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2011
Last Update Date: 12/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 HIGHLAND AVE SUITE 604-PRICE MEDICAL OFFICE BUILDING
ABINGTON PA
19001-3714
US

IV. Provider business mailing address

1245 HIGHLAND AVE SUITE 604-PRICE MEDICAL OFFICE BUILDING
ABINGTON PA
19001-3714
US

V. Phone/Fax

Practice location:
  • Phone: 215-481-7464
  • Fax:
Mailing address:
  • Phone: 215-481-7464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP011098
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: