Provider Demographics
NPI:1326681313
Name:HUMPHRIES, TIFFANY FRANCES AYAME (NP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:FRANCES AYAME
Last Name:HUMPHRIES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 WILLIAMSBURG ST APT 301
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-5825
Mailing Address - Country:US
Mailing Address - Phone:903-431-7868
Mailing Address - Fax:
Practice Address - Street 1:4501 EMPIRE CT
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-1949
Practice Address - Country:US
Practice Address - Phone:540-371-0079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024178176363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner