Provider Demographics
NPI:1417380312
Name:PITTMAN, TARESA (PMHNP)
Entity Type:Individual
Prefix:
First Name:TARESA
Middle Name:
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 BORDEAUX BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702
Mailing Address - Country:US
Mailing Address - Phone:302-365-0384
Mailing Address - Fax:
Practice Address - Street 1:102 SLEEPY HOLLOW DR
Practice Address - Street 2:SUITE 204 BUNKER HILL BUILDING
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-5846
Practice Address - Country:US
Practice Address - Phone:302-365-0384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL8-0000124163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health