Provider Demographics
NPI:1659843522
Name:HERRERA, TIFFANY MAE GUERRA (NP)
Entity Type:Individual
Prefix:
First Name:TIFFANY MAE
Middle Name:GUERRA
Last Name:HERRERA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S BUENA VISTA ST STE 425
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4571
Mailing Address - Country:US
Mailing Address - Phone:818-848-8311
Mailing Address - Fax:
Practice Address - Street 1:201 S BUENA VISTA ST STE 425
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4571
Practice Address - Country:US
Practice Address - Phone:818-848-8311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010661363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily