Provider Demographics
NPI:1073957585
Name:PRIMERO, TIFFANY DEVONNE (NP)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:DEVONNE
Last Name:PRIMERO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 JACKLIN RD
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-4554
Mailing Address - Country:US
Mailing Address - Phone:408-550-2375
Mailing Address - Fax:
Practice Address - Street 1:940 JACKLIN RD
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-4554
Practice Address - Country:US
Practice Address - Phone:408-550-2375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-26
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22759363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily