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General NPI Number Information
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NPI Number | 1669147443
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Entity Type | Individual
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Provider Name | KRISTA TKACZ NP-C
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Gender | Female
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Dates
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Enumeration Date | 08/12/2021
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Last Update Date | 09/22/2021
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Provider Practice Location Address
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Address Line | 932 S MAIN ST
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City | PLEASANTVILLE
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State | NJ
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Zip | 08232-3646
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Country | US
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Telephone | 800-486-0131
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Fax |
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Provider Business Mailing Address
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Address Line | 54 TAILOR LN
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City | SICKLERVILLE
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State | NJ
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Zip | 08081-5699
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Country | US
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Telephone | 609-289-7089
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 26NJ01190000
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License Number State | NJ
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