Provider Demographics
NPI:1184375305
Name:TIERNEY, NICOLE M (CRNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:TIERNEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:M
Other - Last Name:HECKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1431 NURSERY ST # 102
Mailing Address - Street 2:
Mailing Address - City:FOGELSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18051-1612
Mailing Address - Country:US
Mailing Address - Phone:610-336-8277
Mailing Address - Fax:610-821-1358
Practice Address - Street 1:1431 NURSERY ST # 102
Practice Address - Street 2:
Practice Address - City:FOGELSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18051-1612
Practice Address - Country:US
Practice Address - Phone:610-336-8277
Practice Address - Fax:610-821-1358
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP025042363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP025042OtherSTATE LICENSE