Healthcare Provider Details

I. General information

NPI: 1710742937
Provider Name (Legal Business Name): TANYA M HRICIK CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2024
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1097 N CHURCH ST
HAZLE TOWNSHIP PA
18202-1465
US

IV. Provider business mailing address

1097 N CHURCH ST
HAZLE TOWNSHIP PA
18202-1465
US

V. Phone/Fax

Practice location:
  • Phone: 272-639-5650
  • Fax: 272-639-5651
Mailing address:
  • Phone: 272-639-5650
  • Fax: 272-639-5651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP028454
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: