Provider Demographics
NPI:1851097398
Name:ROBERTS, TIFFANI KIRSTEN (RN)
Entity Type:Individual
Prefix:
First Name:TIFFANI
Middle Name:KIRSTEN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 SAWYER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303-3412
Mailing Address - Country:US
Mailing Address - Phone:970-335-2073
Mailing Address - Fax:970-247-9126
Practice Address - Street 1:281 SAWYER DR STE 300
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-3412
Practice Address - Country:US
Practice Address - Phone:970-335-2073
Practice Address - Fax:970-247-9126
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1648267163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse