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General NPI Number Information
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NPI Number | 1306190566
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Entity Type | Individual
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Provider Name | MARK BRIAN BIXBY CRNP
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Gender | Male
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Dates
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Enumeration Date | 11/08/2012
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Last Update Date | 12/16/2021
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Provider Practice Location Address
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Address Line | 680 BLAIR MILL RD
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City | HORSHAM
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State | PA
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Zip | 19044-2223
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Country | US
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Telephone | 215-260-0637
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Fax |
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Provider Business Mailing Address
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Address Line | 4508 CHESTNUT ST
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City | PHILADELPHIA
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State | PA
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Zip | 19139-3608
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Country | US
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Telephone | 267-787-8300
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Fax | 267-787-8140
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | TP004573P
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | TP004573P
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License Number State | PA
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