Provider Demographics
NPI:1184020554
Name:SMITH, TYREE DARNELL (MSN, CRNP, CPNP-AC)
Entity Type:Individual
Prefix:
First Name:TYREE
Middle Name:DARNELL
Last Name:SMITH
Suffix:
Gender:M
Credentials:MSN, CRNP, CPNP-AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 MERRIBROOK LN
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-2717
Mailing Address - Country:US
Mailing Address - Phone:215-888-1901
Mailing Address - Fax:
Practice Address - Street 1:34 STREET AND CIVIC CENTER BLVD
Practice Address - Street 2:1ST FLOOR WOOD BUILDING
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-590-3440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-13
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014445363LP0200X, 363LA2100X, 363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care