Provider Demographics
NPI:1598946188
Name:BURNS, TIFFANY A
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:A
Last Name:BURNS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6081 SCHIEFERSTINE RD
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-8042
Mailing Address - Country:US
Mailing Address - Phone:315-525-7893
Mailing Address - Fax:
Practice Address - Street 1:6081 SCHIEFERSTINE RD
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-8042
Practice Address - Country:US
Practice Address - Phone:315-525-7893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-24
Last Update Date:2007-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY265288-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse