Healthcare Provider Details

I. General information

NPI: 1417142514
Provider Name (Legal Business Name): ANN MARIE THERESA STORBRAUCK CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS ANN MARIE THERESA MIGNONA

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2813 LEE DR
JAMISON PA
18929-1047
US

IV. Provider business mailing address

30 S 15TH ST STE 1550
PHILADELPHIA PA
19102-4806
US

V. Phone/Fax

Practice location:
  • Phone: 267-884-4788
  • Fax: 215-798-9726
Mailing address:
  • Phone: 267-884-4788
  • Fax: 215-798-9726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP018884
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR149292
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209029491
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP009486
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ00297900
License Number StateNJ
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number30454
License Number StateSC
# 7
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number32914
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: