Provider Demographics
NPI:1386204956
Name:SOMERS, TIFFANY CHANTEL (LPN)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:CHANTEL
Last Name:SOMERS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 E 95TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-2501
Mailing Address - Country:US
Mailing Address - Phone:646-665-0627
Mailing Address - Fax:337-777-1619
Practice Address - Street 1:1881 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-1128
Practice Address - Country:US
Practice Address - Phone:212-427-1342
Practice Address - Fax:337-777-1619
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309285164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse