Healthcare Provider Details

I. General information

NPI: 1104546068
Provider Name (Legal Business Name): TAMIKIO P ANDERSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 W BALTIMORE AVE STE 101
MEDIA PA
19063-3740
US

IV. Provider business mailing address

3803 W CHESTER PIKE STE 160
NEWTOWN SQUARE PA
19073-2336
US

V. Phone/Fax

Practice location:
  • Phone: 484-227-0900
  • Fax: 484-227-2132
Mailing address:
  • Phone: 484-227-0900
  • Fax: 484-227-2132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP026222
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP026222
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: