Provider Demographics
NPI:1922499151
Name:PENA, TIFFANY ADKINS (NP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ADKINS
Last Name:PENA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6150 BAYFIELD PKWY
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-7486
Mailing Address - Country:US
Mailing Address - Phone:704-262-6081
Mailing Address - Fax:
Practice Address - Street 1:6150 BAYFIELD PKWY
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-7486
Practice Address - Country:US
Practice Address - Phone:704-262-6081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-10
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007454363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily