Provider Demographics
NPI:1407116502
Name:SKARIA, TINTU THOMAS (CRNP)
Entity Type:Individual
Prefix:
First Name:TINTU
Middle Name:THOMAS
Last Name:SKARIA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:TINTU
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1515 THE FAIRWAY
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-1491
Mailing Address - Country:US
Mailing Address - Phone:215-885-6800
Mailing Address - Fax:215-885-2491
Practice Address - Street 1:1515 THE FAIRWAY
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-1491
Practice Address - Country:US
Practice Address - Phone:215-885-6800
Practice Address - Fax:215-885-2491
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011692363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health