Provider Demographics
NPI:1750570131
Name:MINNOCK, PANTEA PARSA (RN, CPNP)
Entity type:Individual
Prefix:MRS
First Name:PANTEA
Middle Name:PARSA
Last Name:MINNOCK
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Gender:F
Credentials:RN, CPNP
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Mailing Address - Street 1:34TH STREET AND CIVIC CENTER BLVD.
Mailing Address - Street 2:11TH FLOOR NW TOWER, SUITE 30
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104
Mailing Address - Country:US
Mailing Address - Phone:215-590-3618
Mailing Address - Fax:215-590-3053
Practice Address - Street 1:34TH STREET AND CIVIC CENTER BLVD
Practice Address - Street 2:11TH FLOOR NW TOWER, SUITE 30
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-590-3618
Practice Address - Fax:215-590-3053
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2008-09-10
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Provider Licenses
StateLicense IDTaxonomies
PASP009934363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics