Provider Demographics
NPI:1699024497
Name:RICKERTSEN, TIFFANY K (ARNP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:K
Last Name:RICKERTSEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:K
Other - Last Name:PETERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-1851
Mailing Address - Fax:319-356-4855
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-1851
Practice Address - Fax:319-356-4855
Is Sole Proprietor?:No
Enumeration Date:2012-09-07
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA112954363LF0000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily