Provider Demographics
NPI:1699052225
Name:VERMILYA, TRICIA L (CRNP)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:L
Last Name:VERMILYA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:L
Other - Last Name:CRUTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:4801 SAUCON CREEK RD
Mailing Address - Street 2:STE 110
Mailing Address - City:CENTER VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18034-9068
Mailing Address - Country:US
Mailing Address - Phone:570-420-4951
Mailing Address - Fax:570-476-3754
Practice Address - Street 1:200 E BROWN ST
Practice Address - Street 2:IMMEDIATE CARE CENTER
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-3006
Practice Address - Country:US
Practice Address - Phone:570-476-3700
Practice Address - Fax:570-476-3637
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011751363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily