Provider Demographics
NPI:1730447954
Name:DIPPOLITO, THERESA M (FNP-C)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:M
Last Name:DIPPOLITO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 MARKET ST
Mailing Address - Street 2:7TH FLOOR, SUITE 741
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5502
Mailing Address - Country:US
Mailing Address - Phone:215-349-5200
Mailing Address - Fax:215-615-0038
Practice Address - Street 1:3701 MARKET ST
Practice Address - Street 2:7TH FLOOR, SUITE 741
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5502
Practice Address - Country:US
Practice Address - Phone:215-349-5200
Practice Address - Fax:215-615-0038
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0011545363L00000X
PASP011912363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner