Provider Demographics
NPI:1649916685
Name:GALLAGHER, TANYA MARIE (CRNP)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:MARIE
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:MARIE
Other - Last Name:ATIYEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3469 PICKERTOWN RD
Mailing Address - Street 2:
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-3567
Mailing Address - Country:US
Mailing Address - Phone:484-661-8796
Mailing Address - Fax:
Practice Address - Street 1:150 ALLENDALE RD STE 1130
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-2926
Practice Address - Country:US
Practice Address - Phone:610-393-1253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP025722363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health