Provider Demographics
NPI:1790156701
Name:GILL, TRICIA (CRNP)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name:GILL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 TOWNSHIP LINE RD
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-5552
Mailing Address - Country:US
Mailing Address - Phone:215-860-0775
Mailing Address - Fax:
Practice Address - Street 1:777 TOWNSHIP LINE RD
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-5552
Practice Address - Country:US
Practice Address - Phone:215-860-0775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-16
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015447363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner