Provider Demographics
NPI:1679952253
Name:AGBONIFIOROR, TESSA (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:
Last Name:AGBONIFIOROR
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:TESSA
Other - Middle Name:
Other - Last Name:COVERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7901 STATE RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19136-3407
Mailing Address - Country:US
Mailing Address - Phone:717-495-5049
Mailing Address - Fax:
Practice Address - Street 1:7901 STATE RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19136-3407
Practice Address - Country:US
Practice Address - Phone:215-685-7843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-28
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014772363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care