Provider Demographics
NPI:1609881382
Name:TYER, TIFFANI N (CRNP)
Entity Type:Individual
Prefix:MS
First Name:TIFFANI
Middle Name:N
Last Name:TYER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:TIFFANI
Other - Middle Name:N
Other - Last Name:HATCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:PO BOX 64620
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4620
Mailing Address - Country:US
Mailing Address - Phone:410-328-3037
Mailing Address - Fax:410-328-3040
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:GUDELSKY BASEMENT
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-3037
Practice Address - Fax:410-328-3040
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR146119363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD403778200Medicaid
MD403778200Medicaid
MDI157Medicare PIN
MDQ11259Medicare UPIN