Provider Demographics
NPI:1699047449
Name:POPE, TRICIA S (LPN)
Entity type:Individual
Prefix:MS
First Name:TRICIA
Middle Name:S
Last Name:POPE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:TRICIA
Other - Middle Name:S
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:373 BROADWAY
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2707
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:373 BROADWAY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2707
Practice Address - Country:US
Practice Address - Phone:631-608-8523
Practice Address - Fax:631-608-8527
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305070164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse