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General NPI Number Information
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NPI Number | 1679952253
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Entity Type | Individual
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Provider Name | TESSA AGBONIFIOROR AGACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 05/28/2015
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Last Update Date | 05/02/2024
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Provider Practice Location Address
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Address Line | 7901 STATE RD
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City | PHILADELPHIA
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State | PA
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Zip | 19136-3407
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Country | US
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Telephone | 215-685-7843
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Fax |
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Provider Business Mailing Address
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Address Line | 7901 STATE RD
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City | PHILADELPHIA
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State | PA
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Zip | 19136-3407
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Country | US
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Telephone | 717-495-5049
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | SP014772
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License Number State | PA
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