Provider Demographics
NPI:1396517496
Name:WAKIM, TIFFANY CLAIRE (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:CLAIRE
Last Name:WAKIM
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 E ILLINOIS ST UNIT 5509
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-0820
Mailing Address - Country:US
Mailing Address - Phone:630-408-3563
Mailing Address - Fax:
Practice Address - Street 1:2955 W 95TH ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2409
Practice Address - Country:US
Practice Address - Phone:708-422-0022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.028519363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily