Provider Demographics
NPI:1831128461
Name:LANCASTER, TIFFANY CLARKE (CPNP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:CLARKE
Last Name:LANCASTER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10410 RIDGEFIELD PARKWAY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233
Mailing Address - Country:US
Mailing Address - Phone:804-754-3776
Mailing Address - Fax:804-754-0880
Practice Address - Street 1:10410 RIDGEFIELD PARKWAY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233
Practice Address - Country:US
Practice Address - Phone:804-754-3776
Practice Address - Fax:804-754-0880
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166969363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010293979Medicaid
VA010293987Medicaid
VA010293979OtherVA PAREMIER KENB
VA224189800OtherDOL
VA010293987OtherVA PREMIER SOUTH HILL
VA010294011Medicaid
VA498906Medicare Oscar/Certification
VA010293987Medicaid
VA010293979OtherVA PAREMIER KENB
VA010294011Medicaid
VA493869Medicare Oscar/Certification