Provider Demographics
NPI:1578653697
Name:SIMONS, TIFFANY G (NP)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:G
Last Name:SIMONS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1101 SAM PERRY BLVD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4467
Mailing Address - Country:US
Mailing Address - Phone:540-373-2244
Mailing Address - Fax:540-371-4849
Practice Address - Street 1:1101 SAM PERRY BLVD
Practice Address - Street 2:SUITE 211
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4467
Practice Address - Country:US
Practice Address - Phone:540-373-2244
Practice Address - Fax:540-371-4849
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024165413363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009582S47Medicare ID - Type Unspecified