Healthcare Provider Details

I. General information

NPI: 1316454051
Provider Name (Legal Business Name): REBECCA LYNN DARRAGH CRNP AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 FRANKFORD AVE
PHILADELPHIA PA
19124-2620
US

IV. Provider business mailing address

3343 HARTEL AVE
PHILADELPHIA PA
19136-3025
US

V. Phone/Fax

Practice location:
  • Phone: 215-831-2218
  • Fax:
Mailing address:
  • Phone: 215-776-2967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN623999
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberSP018324
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: