Individual
TINA THACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
1930 S BROAD ST, PHILADELPHIA, PA 19145-2328
(267) 752-9203
Mailing address
1831 S NEWKIRK ST, PHILADELPHIA, PA 19145-1628
(267) 752-9203
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
RN635595
PA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
SP025735
PA
Other
Enumeration date
04/01/2022
Last updated
06/30/2023
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