Provider Demographics
NPI:1093055667
Name:ROMERO PERALTA, TIFFANY (ACNS-BC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:ROMERO PERALTA
Suffix:
Gender:F
Credentials:ACNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BELEN
Mailing Address - State:NM
Mailing Address - Zip Code:87002-3605
Mailing Address - Country:US
Mailing Address - Phone:505-864-4646
Mailing Address - Fax:
Practice Address - Street 1:101 N 6TH ST
Practice Address - Street 2:
Practice Address - City:BELEN
Practice Address - State:NM
Practice Address - Zip Code:87002-3605
Practice Address - Country:US
Practice Address - Phone:505-864-4646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNS-00241364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health