Provider Demographics
NPI:1649745498
Name:LESTER, TIFFANIE LYNN (CRNP)
Entity Type:Individual
Prefix:MS
First Name:TIFFANIE
Middle Name:LYNN
Last Name:LESTER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:TIFFANIE
Other - Middle Name:LYNN
Other - Last Name:LESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:608 MARTIN RD
Mailing Address - Street 2:
Mailing Address - City:ROSTRAVER TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15012-4835
Mailing Address - Country:US
Mailing Address - Phone:724-963-8677
Mailing Address - Fax:
Practice Address - Street 1:4905 WILLIAM PENN HWY
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3757
Practice Address - Country:US
Practice Address - Phone:724-519-8350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019315363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103567390-0001Medicaid