Provider Demographics
NPI:1376240945
Name:CRIST, TIFFANY ANN (RN)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANN
Last Name:CRIST
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 1:1540 VINE ST APT 440
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90028-4028
Mailing Address - Country:US
Mailing Address - Phone:310-779-6242
Mailing Address - Fax:
Practice Address - Street 1:1540 VINE ST APT 440
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90028-4028
Practice Address - Country:US
Practice Address - Phone:310-779-6242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA630871163WC0200X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA630871OtherCALIFORNIA BOARD OF NURSING