Provider Demographics
NPI:1093142754
Name:KALITA, TIFFANY J (FPA, APRN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:J
Last Name:KALITA
Suffix:
Gender:F
Credentials:FPA, APRN, FNP-BC
Other - Prefix:MRS
Other - First Name:TIFFANY
Other - Middle Name:J
Other - Last Name:FARRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FPA, APRN, FNP-BC
Mailing Address - Street 1:2900 FOXFIELD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-5799
Mailing Address - Country:US
Mailing Address - Phone:630-377-6500
Mailing Address - Fax:630-377-6577
Practice Address - Street 1:2900 FOXFIELD RD STE 100
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-5799
Practice Address - Country:US
Practice Address - Phone:630-377-6500
Practice Address - Fax:630-377-6577
Is Sole Proprietor?:No
Enumeration Date:2013-09-26
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010752363LF0000X
IL277000491363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily