Provider Demographics
NPI:1972667061
Name:FARREY, TIFFANI NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:TIFFANI
Middle Name:NICOLE
Last Name:FARREY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TIFFANI
Other - Middle Name:NICOLE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:10 CLINICAL CENTER DRIVE
Mailing Address - Street 2:BLDG 10 RM 5-1471
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892
Mailing Address - Country:US
Mailing Address - Phone:301-594-7650
Mailing Address - Fax:301-480-0230
Practice Address - Street 1:10 CLINICAL CENTER DRIVE
Practice Address - Street 2:BLDG 10 RM 5-1471
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892
Practice Address - Country:US
Practice Address - Phone:301-594-7650
Practice Address - Fax:301-480-0230
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003904363AM0700X
TXPA05089363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical