Provider Demographics
NPI:1083942106
Name:TANZIO, CAROL L (CRNP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:L
Last Name:TANZIO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 S NEW MIDDLETOWN RD
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5255
Mailing Address - Country:US
Mailing Address - Phone:610-627-3690
Mailing Address - Fax:610-627-3684
Practice Address - Street 1:176 S NEW MIDDLETOWN RD
Practice Address - Street 2:MOB, 1ST FLOOR
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5255
Practice Address - Country:US
Practice Address - Phone:610-627-3690
Practice Address - Fax:610-627-3684
Is Sole Proprietor?:No
Enumeration Date:2009-12-01
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010610363LF0000X
PARN505951L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse