Provider Demographics
NPI:1255058012
Name:TOURLITIS, NICOLE SAMANTHA (CRNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:SAMANTHA
Last Name:TOURLITIS
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 1:609 W GERMANTOWN PIKE STE 210
Mailing Address - Street 2:
Mailing Address - City:EAST NORRITON
Mailing Address - State:PA
Mailing Address - Zip Code:19403-4251
Mailing Address - Country:US
Mailing Address - Phone:610-649-1175
Mailing Address - Fax:610-279-4841
Practice Address - Street 1:609 W GERMANTOWN PIKE STE 210
Practice Address - Street 2:
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19403-4251
Practice Address - Country:US
Practice Address - Phone:610-649-1175
Practice Address - Fax:610-279-4841
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP027033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty