Provider Demographics
NPI:1952043200
Name:WALCK, TIFFANY LYNN (APN-C)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:LYNN
Last Name:WALCK
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 PLEASANT RD
Mailing Address - Street 2:
Mailing Address - City:HIGH BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08829-1617
Mailing Address - Country:US
Mailing Address - Phone:908-797-9609
Mailing Address - Fax:
Practice Address - Street 1:103 WESCOTT DRIVE
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822
Practice Address - Country:US
Practice Address - Phone:908-237-6910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01291100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily