Provider Demographics
NPI:1083028716
Name:RHODES, TIFFANY (CRNP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:RHODES
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 UNITED DR STE 102
Mailing Address - Street 2:
Mailing Address - City:WEST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02379-1027
Mailing Address - Country:US
Mailing Address - Phone:508-238-8646
Mailing Address - Fax:
Practice Address - Street 1:451 ANDOVER ST STE 110
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5069
Practice Address - Country:US
Practice Address - Phone:978-794-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1123930363LF0000X
MA2300531363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily