Provider Demographics
NPI:1285224220
Name:TATE, TIFFANY JEANETTE (FNP-C)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:JEANETTE
Last Name:TATE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 NORTHWAY DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2030
Mailing Address - Country:US
Mailing Address - Phone:907-644-3239
Mailing Address - Fax:
Practice Address - Street 1:729 NORTHWAY DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2030
Practice Address - Country:US
Practice Address - Phone:907-644-3239
Practice Address - Fax:907-644-3983
Is Sole Proprietor?:No
Enumeration Date:2021-01-23
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK38472163WF0300X
AK174813363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WF0300XNursing Service ProvidersRegistered NurseFlight