Provider Demographics
NPI:1013580695
Name:MAR, TIFFANY C (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:C
Last Name:MAR
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CASTRO AND DUBOCE STREETS
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114
Mailing Address - Country:US
Mailing Address - Phone:707-523-7241
Mailing Address - Fax:707-523-7241
Practice Address - Street 1:CASTRO AND DUBOCE STREETS SUITE 160A
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114
Practice Address - Country:US
Practice Address - Phone:707-523-7241
Practice Address - Fax:707-523-7241
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017625363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily