Provider Demographics
NPI:1376933291
Name:YUSAVITZ, DAVID TANNEY (CRNP)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:TANNEY
Last Name:YUSAVITZ
Suffix:
Gender:M
Credentials:CRNP
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Mailing Address - Street 1:101 E OLNEY AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-2470
Mailing Address - Country:US
Mailing Address - Phone:215-456-1825
Mailing Address - Fax:215-456-5926
Practice Address - Street 1:5501 OLD YORK RD # PALEY1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3018
Practice Address - Country:US
Practice Address - Phone:215-456-7170
Practice Address - Fax:215-456-4923
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-30
Last Update Date:2022-01-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PASP014730363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics