Provider Demographics
NPI:1285184150
Name:JAMISON, TIFANY (APN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:TIFANY
Middle Name:
Last Name:JAMISON
Suffix:
Gender:F
Credentials:APN, FNP-BC
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 2591
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-1092
Mailing Address - Country:US
Mailing Address - Phone:708-979-9788
Mailing Address - Fax:
Practice Address - Street 1:230 W MONROE ST
Practice Address - Street 2:SUITE 2540
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-4703
Practice Address - Country:US
Practice Address - Phone:708-979-9788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-04
Last Update Date:2017-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014920363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily