Provider Demographics
NPI:1669752242
Name:CLEMONS, TIFFANY MICHELE (LPN)
Entity type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:MICHELE
Last Name:CLEMONS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 OAK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-4644
Mailing Address - Country:US
Mailing Address - Phone:845-321-1108
Mailing Address - Fax:
Practice Address - Street 1:20 OLD POST RD N
Practice Address - Street 2:
Practice Address - City:RED HOOK
Practice Address - State:NY
Practice Address - Zip Code:12571-2219
Practice Address - Country:US
Practice Address - Phone:845-758-1816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-26
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302125164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse