Provider Demographics
NPI:1427546688
Name:KHAIRALLAH, TOUFIC S (APRN, FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:TOUFIC
Middle Name:S
Last Name:KHAIRALLAH
Suffix:
Gender:M
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 N STERLING AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-3865
Mailing Address - Country:US
Mailing Address - Phone:309-306-1039
Mailing Address - Fax:309-291-0932
Practice Address - Street 1:4501 N STERLING AVE STE 104
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-3865
Practice Address - Country:US
Practice Address - Phone:309-306-1039
Practice Address - Fax:309-679-9581
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-24
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11005547363L00000X
IL277000880363L00000X
IL209.014683363LF0000X, 364SC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No364SC0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCritical Care Medicine