Provider Demographics
NPI:1629880265
Name:JENSEN, TIFFANY LYNN (MHA, MBA)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:LYNN
Last Name:JENSEN
Suffix:
Gender:F
Credentials:MHA, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 MOYERS GROVE RD
Mailing Address - Street 2:
Mailing Address - City:WAPWALLOPEN
Mailing Address - State:PA
Mailing Address - Zip Code:18660-2051
Mailing Address - Country:US
Mailing Address - Phone:570-294-2095
Mailing Address - Fax:
Practice Address - Street 1:751 E 16TH ST
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-2321
Practice Address - Country:US
Practice Address - Phone:570-294-2095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-21
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care