Provider Demographics
NPI:1518759372
Name:EL, TYLISHA RENEE (CRNP)
Entity type:Individual
Prefix:
First Name:TYLISHA
Middle Name:RENEE
Last Name:EL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2712 W CHELTENHAM AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19150-1312
Mailing Address - Country:US
Mailing Address - Phone:215-815-4493
Mailing Address - Fax:215-815-4493
Practice Address - Street 1:1080 N DELAWARE AVE STE 600
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-4339
Practice Address - Country:US
Practice Address - Phone:215-496-0707
Practice Address - Fax:215-496-0707
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP032796363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health