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NPI Code Detail

MEDICARE: DEBORAH JEAN TANCREDI CRNP

MEDICARE: DEBORAH JEAN TANCREDI CRNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerSPO19227PA
2363LF0000XFamily Nurse PractitionerSP019227PA

General Provider Information

NPI Number : 1205319852
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBORAH JEAN TANCREDI CRNP
Provider Business Mailing Address
First Line : 5001 TOWNSHIP LINE RD
Second Line :
City : DREXEL HILL
State : PA
Zip : 19026-4821
Country : US
Telephone Number : 610-209-6667
Fax Number :
Provider Business Practice Location Address
First Line : 5001 TOWNSHIP LINE RD
Second Line :
City : DREXEL HILL
State : PA
Zip : 19026-4821
Country : US
Telephone Number : 610-209-6667
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/10/2018
Last Update Date : 08/09/2022

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