Healthcare Provider Details

I. General information

NPI: 1588198139
Provider Name (Legal Business Name): TINA PIERCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 NATIONAL PIKE W
BROWNSVILLE PA
15417-9216
US

IV. Provider business mailing address

410 NATIONAL PIKE W
BROWNSVILLE PA
15417-9216
US

V. Phone/Fax

Practice location:
  • Phone: 724-970-3798
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP017438
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: