Provider Demographics
NPI:1578931986
Name:TOE, TIFFANY (LM, CPM)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:TOE
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 JUAN TABO BLVD NE
Mailing Address - Street 2:B6
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-1994
Mailing Address - Country:US
Mailing Address - Phone:505-615-4914
Mailing Address - Fax:
Practice Address - Street 1:2705 JUAN TABO BLVD NE
Practice Address - Street 2:B6
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-1994
Practice Address - Country:US
Practice Address - Phone:505-615-4914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM15149R175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay