Provider Demographics
NPI:1306202148
Name:SACKOR, TARNYENOH
Entity Type:Individual
Prefix:MISS
First Name:TARNYENOH
Middle Name:
Last Name:SACKOR
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TARNYENOH
Other - Middle Name:SACKOR
Other - Last Name:BARGBLOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6844 CLOVER LN
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-5303
Mailing Address - Country:US
Mailing Address - Phone:267-292-2876
Mailing Address - Fax:267-292-2936
Practice Address - Street 1:6844 CLOVER LN
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-5303
Practice Address - Country:US
Practice Address - Phone:267-292-2876
Practice Address - Fax:267-292-2936
Is Sole Proprietor?:No
Enumeration Date:2016-01-09
Last Update Date:2016-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN300843164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse