Provider Demographics
NPI:1790930733
Name:DRAKE, TIFFINNY (NP)
Entity Type:Individual
Prefix:
First Name:TIFFINNY
Middle Name:
Last Name:DRAKE
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 1:2340 CLAY ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-1932
Mailing Address - Country:US
Mailing Address - Phone:415-600-1100
Mailing Address - Fax:
Practice Address - Street 1:2020 6TH AVE
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-6123
Practice Address - Country:US
Practice Address - Phone:732-202-8071
Practice Address - Fax:732-922-6026
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 150612278P3800X
CA15061363LF0000X
NJ26NJ00967400363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No2278P3800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedPalliative/Hospice
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily