Healthcare Provider Details

I. General information

NPI: 1891975959
Provider Name (Legal Business Name): THERESA SHARP SMIGO MSN, CRNP, CNS, RN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 03/20/2021
Certification Date: 12/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N 9TH ST
PHILA PA
19107-1813
US

IV. Provider business mailing address

404 AURA RD
GLASSBORO NJ
08028-3206
US

V. Phone/Fax

Practice location:
  • Phone: 267-337-1534
  • Fax:
Mailing address:
  • Phone: 267-337-1534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberTP006435C
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: