Provider Demographics
NPI:1891070405
Name:TOMKO, LISA A (CRNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:TOMKO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:A
Other - Last Name:GASTLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:785 5TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-709-6553
Mailing Address - Fax:717-709-6529
Practice Address - Street 1:22 ST PAUL DR STE 204
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1036
Practice Address - Country:US
Practice Address - Phone:172-176-9447
Practice Address - Fax:717-217-6955
Is Sole Proprietor?:No
Enumeration Date:2011-10-14
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011661363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2678742OtherHIGHMARK BLUE SHIELD - FREEDOM BLUE
PA102735365Medicaid
PA1603330OtherGATEWAY MEDICARE ASSURED
PAP01007857Medicare PIN