Provider Demographics
NPI:1235595067
Name:DAI, TIFFANIE (FNP)
Entity Type:Individual
Prefix:
First Name:TIFFANIE
Middle Name:
Last Name:DAI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4719 QUAIL LAKES DR STE G
Mailing Address - Street 2:TIFFANIE DAI PMB# 274
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5267
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4719 QUAIL LAKES DR STE G
Practice Address - Street 2:PMB#274
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5267
Practice Address - Country:US
Practice Address - Phone:209-952-2633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-08
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004034363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily