Provider Demographics
NPI:1306472717
Name:DIRICKSON-FORD, TIFFANY GLADYS (CRNP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:GLADYS
Last Name:DIRICKSON-FORD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP
Mailing Address - Street 1:1050 CONNECTICUT AVE NW STE 500
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-5304
Mailing Address - Country:US
Mailing Address - Phone:202-596-8891
Mailing Address - Fax:
Practice Address - Street 1:1050 CONNECTICUT AVE NW STE 500
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-5304
Practice Address - Country:US
Practice Address - Phone:202-596-8891
Practice Address - Fax:833-941-2357
Is Sole Proprietor?:No
Enumeration Date:2020-03-17
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDF0819091363LF0000X
DCNP500016115363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily