Provider Demographics
NPI:1275963506
Name:REITSMA, TIFFANY (CNP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:REITSMA
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:M
Other - Last Name:CRISP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1205 S GRANGE AVE
Practice Address - Street 2:STE 104
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-0407
Practice Address - Country:US
Practice Address - Phone:605-328-8500
Practice Address - Fax:605-328-8501
Is Sole Proprietor?:No
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000814363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily