Provider Demographics
NPI:1326656976
Name:GREGORY, ANN TIFFANY
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:TIFFANY
Last Name:GREGORY
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 1:24 CIRCUIT RD
Mailing Address - Street 2:
Mailing Address - City:BELLPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11713-2904
Mailing Address - Country:US
Mailing Address - Phone:631-708-8281
Mailing Address - Fax:
Practice Address - Street 1:24 CIRCUIT RD
Practice Address - Street 2:
Practice Address - City:BELLPORT
Practice Address - State:NY
Practice Address - Zip Code:11713-2904
Practice Address - Country:US
Practice Address - Phone:631-708-8281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309962-1164W00000X
NY807173-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse