Provider Demographics
NPI:1013470194
Name:LUONGO, TIFFANY MICHELLE (FNP, RN)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:MICHELLE
Last Name:LUONGO
Suffix:
Gender:F
Credentials:FNP, RN
Other - Prefix:MS
Other - First Name:TIFFANY
Other - Middle Name:MICHELLE
Other - Last Name:PAOLILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP, RN
Mailing Address - Street 1:36 WHITE STREET
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-1449
Mailing Address - Country:US
Mailing Address - Phone:617-876-5519
Mailing Address - Fax:
Practice Address - Street 1:36 WHITE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-1449
Practice Address - Country:US
Practice Address - Phone:617-876-5519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-07
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2289065163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse