Provider Demographics
NPI:1326209495
Name:BOCCHINO, NANCY L (CRNP)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:L
Last Name:BOCCHINO
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 1:4508 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-3608
Mailing Address - Country:US
Mailing Address - Phone:267-787-8300
Mailing Address - Fax:267-787-8140
Practice Address - Street 1:4508 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-3608
Practice Address - Country:US
Practice Address - Phone:215-746-6894
Practice Address - Fax:214-746-7838
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASPOO1895H261QP2300X
PASP001895H363L00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMB1386007OtherDEA NUMBER