Provider Demographics
NPI:1235816109
Name:FREER, TIFFANY
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:FREER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9081
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA STATE UNIVERSITY
Mailing Address - State:VA
Mailing Address - Zip Code:23806-0001
Mailing Address - Country:US
Mailing Address - Phone:720-256-6735
Mailing Address - Fax:
Practice Address - Street 1:VSU-CE DOUGLAS L WILDER BUILDING CARTER G WOODSON AVE
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23806-0001
Practice Address - Country:US
Practice Address - Phone:804-524-5847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-30
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No174H00000XOther Service ProvidersHealth Educator