Provider Demographics
NPI:1851145551
Name:TUCKER, TIFFANEE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:TIFFANEE
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 7TH ST
Mailing Address - Street 2:
Mailing Address - City:HOQUIAM
Mailing Address - State:WA
Mailing Address - Zip Code:98550-2506
Mailing Address - Country:US
Mailing Address - Phone:360-532-5454
Mailing Address - Fax:
Practice Address - Street 1:201 7TH ST
Practice Address - Street 2:
Practice Address - City:HOQUIAM
Practice Address - State:WA
Practice Address - Zip Code:98550-2506
Practice Address - Country:US
Practice Address - Phone:360-532-5454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61163696163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse