Provider Demographics
NPI:1477608479
Name:SOPER, TIFFANY AMRICH (RN, FNP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:AMRICH
Last Name:SOPER
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 STANIFORD ST
Mailing Address - Street 2:SUITE 340
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2517
Mailing Address - Country:US
Mailing Address - Phone:617-726-8722
Mailing Address - Fax:617-724-8534
Practice Address - Street 1:50 STANIFORD ST
Practice Address - Street 2:SUITE 340
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2517
Practice Address - Country:US
Practice Address - Phone:617-726-8722
Practice Address - Fax:617-724-8534
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA260844363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily