Provider Demographics
NPI:1427342781
Name:DOCKERY, TAHIRA (CRNP)
Entity type:Individual
Prefix:MRS
First Name:TAHIRA
Middle Name:
Last Name:DOCKERY
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 1:93 OLD YORK RD # 1-526
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3925
Mailing Address - Country:US
Mailing Address - Phone:267-291-4513
Mailing Address - Fax:215-701-5888
Practice Address - Street 1:157 BUSTLETON PIKE # 161
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6480
Practice Address - Country:US
Practice Address - Phone:215-322-0222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011319363LF0000X
PACW0169251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1326484684Medicaid