Provider Demographics
NPI:1750930764
Name:SOTTILE, TIFFANY ANN (CRNP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANN
Last Name:SOTTILE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 INSTITUTION DR
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTE
Mailing Address - State:PA
Mailing Address - Zip Code:16823-1665
Mailing Address - Country:US
Mailing Address - Phone:814-353-3630
Mailing Address - Fax:
Practice Address - Street 1:301 INSTITUTION DR
Practice Address - Street 2:
Practice Address - City:BELLEFONTE
Practice Address - State:PA
Practice Address - Zip Code:16823-1665
Practice Address - Country:US
Practice Address - Phone:814-353-3630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2019-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020779363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily