Healthcare Provider Details

I. General information

NPI: 1356941157
Provider Name (Legal Business Name): OBOT GRACE TIGAH DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. OBOT OFFIONG UFFEN

II. Dates (important events)

Enumeration Date: 10/30/2020
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 CHESTNUT ST
UPPER DARBY PA
19082-3156
US

IV. Provider business mailing address

1322 KIMBERLY DR
PHILADELPHIA PA
19151-2833
US

V. Phone/Fax

Practice location:
  • Phone: 215-351-5500
  • Fax:
Mailing address:
  • Phone: 215-459-9480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberSP028596
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: