Active NPI
Rachel Tkaczyk, CRNP
- Pediatric Nurse Practitioner
- Philadelphia, PA
National Provider Identifier
1912281114
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- SP011610
- Practice address
- 34TH Street and Civic Center Blvd
Philadelphia, PA 19104 - Phone
- (215) 590-3233
- NPI assigned
- Oct 6, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | SP011610 | PA | Primary |
Addresses
Primary practice location
34TH Street and Civic Center Blvd
Philadelphia, PA 19104
Mailing address
34TH Street and Civic Center Blvd
Philadelphia, PA 19104
Phone (215) 590-3233
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SP011610 | PA | MD | Pediatric Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317859200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1493942400000",
"number": "1912281114",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "34TH STREET AND CIVIC CENTER BLVD",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "19104",
"telephone_number": "215-590-3233"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "34TH STREET AND CIVIC CENTER BLVD",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "19104",
"telephone_number": "215-590-3233"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TKACZYK",
"first_name": "RACHEL",
"credential": "CRNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-10-06",
"last_updated": "2017-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "PA",
"license": "SP011610",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.