Provider Demographics
NPI:1881617587
Name:GAINES, TIFFANY (CRNP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:GAINES
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Gender:F
Credentials:CRNP
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:985 PRINCE FREDERICK BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-3492
Mailing Address - Country:US
Mailing Address - Phone:410-535-2005
Mailing Address - Fax:410-535-7850
Practice Address - Street 1:985 PRINCE FREDERICK BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3492
Practice Address - Country:US
Practice Address - Phone:410-535-2005
Practice Address - Fax:410-535-4850
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2022-07-21
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Provider Licenses
StateLicense IDTaxonomies
MDR134720363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology