Provider Demographics
NPI:1821706698
Name:MIDDLETON, ROGER TOMMY JR (DNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:TOMMY
Last Name:MIDDLETON
Suffix:JR
Gender:M
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 W LINFIELD TRAPPE RD STE 1000
Mailing Address - Street 2:
Mailing Address - City:LIMERICK
Mailing Address - State:PA
Mailing Address - Zip Code:19468-4275
Mailing Address - Country:US
Mailing Address - Phone:610-495-2300
Mailing Address - Fax:
Practice Address - Street 1:420 W LINFIELD TRAPPE RD STE 1000
Practice Address - Street 2:
Practice Address - City:LIMERICK
Practice Address - State:PA
Practice Address - Zip Code:19468-4275
Practice Address - Country:US
Practice Address - Phone:610-495-2650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-10
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP026400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily