Provider Demographics
NPI:1114747722
Name:TERRY, TIFFANY (LPN)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:TERRY
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 1:23 PROSPECT ST # B
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-4636
Mailing Address - Country:US
Mailing Address - Phone:201-428-0210
Mailing Address - Fax:
Practice Address - Street 1:23 PROSPECT ST # B
Practice Address - Street 2:A
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618-4636
Practice Address - Country:US
Practice Address - Phone:201-428-0210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP08110800164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse