Provider Demographics
NPI:1790988111
Name:TIGHE, BURJESSA ELLEN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:BURJESSA
Middle Name:ELLEN
Last Name:TIGHE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 SW NYE ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-3821
Mailing Address - Country:US
Mailing Address - Phone:541-265-4179
Mailing Address - Fax:541-265-4194
Practice Address - Street 1:1010 SW COAST HWY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-5288
Practice Address - Country:US
Practice Address - Phone:541-265-4947
Practice Address - Fax:541-574-7670
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN278554363LF0000X
OR201704952NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR98109Medicare UPIN