Provider Demographics
NPI:1063856045
Name:CARTER SKILLINGS, TIFFANY NICOLE (LM, CPM, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:NICOLE
Last Name:CARTER SKILLINGS
Suffix:
Gender:F
Credentials:LM, CPM, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 FOREST FALLS DR
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-7005
Mailing Address - Country:US
Mailing Address - Phone:207-517-0386
Mailing Address - Fax:207-560-9405
Practice Address - Street 1:40 FOREST FALLS DR
Practice Address - Street 2:
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-7005
Practice Address - Country:US
Practice Address - Phone:207-517-0386
Practice Address - Fax:207-560-9405
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECPM650176B00000X
MEL-136153174N00000X, 174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty
No176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MECPM650OtherSTATE OF MAINE
L136153OtherIBCLC ID
ME14030014OtherNARM ID
ME205089OtherALPP ID