Provider Demographics
NPI:1265613442
Name:ROWE, TIFFANY LEE (NP)
Entity type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:LEE
Last Name:ROWE
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 1:55 YARKERDALE DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14615-1033
Mailing Address - Country:US
Mailing Address - Phone:315-515-1553
Mailing Address - Fax:
Practice Address - Street 1:55 YARKERDALE DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14615-1033
Practice Address - Country:US
Practice Address - Phone:315-515-1553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310449363LA2200X
NY281638164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse