Provider Demographics
NPI:1164767976
Name:KIRLIN, GERALDINE (CPNP)
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:
Last Name:KIRLIN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:GERALDINE
Other - Middle Name:KOSMALSKI
Other - Last Name:KIRLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPNP
Mailing Address - Street 1:3601 A ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-1043
Mailing Address - Country:US
Mailing Address - Phone:215-427-8353
Mailing Address - Fax:215-427-5237
Practice Address - Street 1:3601 A ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-1043
Practice Address - Country:US
Practice Address - Phone:215-427-8353
Practice Address - Fax:215-427-5237
Is Sole Proprietor?:No
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP006954D363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics