Basic Information
| Provider Information | |||||||||
| NPI: | 1689338766 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KASCHAK | ||||||||
| FirstName: | TAMMARIS | ||||||||
| MiddleName: | RIVERA | ||||||||
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| Credential: | FNP-BC, AGACNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 824 CLIFFORD AVE | ||||||||
| Address2: | |||||||||
| City: | ARDMORE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190032030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159396725 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 800 WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191075176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007897366 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2021 | ||||||||
| LastUpdateDate: | 10/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | SP024620 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.