Provider Demographics
NPI:1235845694
Name:DEJAIFFE, TIFFANY ANN (RN)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANN
Last Name:DEJAIFFE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14063-1761
Mailing Address - Country:US
Mailing Address - Phone:716-785-6335
Mailing Address - Fax:
Practice Address - Street 1:33 CHURCH ST
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:NY
Practice Address - Zip Code:14063-1761
Practice Address - Country:US
Practice Address - Phone:716-785-6335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY841456163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse