Provider Demographics
NPI:1851862387
Name:THOMAS, TIFFANY MARIE (RN)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:MARIE
Last Name:THOMAS
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 1:606 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1199
Mailing Address - Country:US
Mailing Address - Phone:814-449-6578
Mailing Address - Fax:814-451-6767
Practice Address - Street 1:606 W 2ND ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1199
Practice Address - Country:US
Practice Address - Phone:814-449-6578
Practice Address - Fax:814-451-6767
Is Sole Proprietor?:No
Enumeration Date:2018-12-10
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN690713163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse