Provider Demographics
NPI:1124696562
Name:NAKAMURA, TIFFANY KEHAULANI HANAKO FU
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:KEHAULANI HANAKO FU
Last Name:NAKAMURA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45-337 KAHIKO ST APT C
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-5228
Mailing Address - Country:US
Mailing Address - Phone:808-225-4840
Mailing Address - Fax:
Practice Address - Street 1:165 KAIHOLU ST
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-1967
Practice Address - Country:US
Practice Address - Phone:808-266-7835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-13
Last Update Date:2021-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-64219163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool