Provider Demographics
NPI:1851062509
Name:DIDOMENICO, TRICIA HALUM (APN)
Entity Type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:HALUM
Last Name:DIDOMENICO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 HEATONS MILL DR
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1521
Mailing Address - Country:US
Mailing Address - Phone:973-216-5362
Mailing Address - Fax:
Practice Address - Street 1:591 HEATONS MILL DR
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1521
Practice Address - Country:US
Practice Address - Phone:973-216-5362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01205900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily