Provider Demographics
NPI:1760035935
Name:SMITH GISHIZKY, TIFFANY (DNP, RN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:SMITH GISHIZKY
Suffix:
Gender:F
Credentials:DNP, RN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 2ND ST STE 225
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-3030
Mailing Address - Country:US
Mailing Address - Phone:707-346-6825
Mailing Address - Fax:
Practice Address - Street 1:1001 2ND ST STE 225
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-3030
Practice Address - Country:US
Practice Address - Phone:707-346-6825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95012240363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95012240OtherBOARD OF REGISTERED NURSING