Basic Information
| Provider Information | |||||||||
| NPI: | 1184020554 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | TYREE | ||||||||
| MiddleName: | DARNELL | ||||||||
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| Credential: | MSN, CRNP, CPNP-AC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1609 MERRIBROOK LN | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191512717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158881901 | ||||||||
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| Practice Location | |||||||||
| Address1: | 34 STREET AND CIVIC CENTER BLVD | ||||||||
| Address2: | 1ST FLOOR WOOD BUILDING | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155903440 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2014 | ||||||||
| LastUpdateDate: | 11/14/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | SP014445 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | 363LA2100X | SP014445 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363LP0222X | SP014445 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics, Critical Care |
No ID Information.