Provider Demographics
NPI:1548066871
Name:VISSARI, THOMAS JOSEPH (CRNP)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOSEPH
Last Name:VISSARI
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 REO ST APT A
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-4628
Mailing Address - Country:US
Mailing Address - Phone:724-996-2194
Mailing Address - Fax:
Practice Address - Street 1:419 KELLYS WAY
Practice Address - Street 2:
Practice Address - City:EAST BRADY
Practice Address - State:PA
Practice Address - Zip Code:16028-2003
Practice Address - Country:US
Practice Address - Phone:724-526-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP031949363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily