Provider Demographics
NPI:1336556976
Name:VESELY, TIFFANY (ARNP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:VESELY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8630 FENTON STREET,
Mailing Address - Street 2:SUITE 1204
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910
Mailing Address - Country:US
Mailing Address - Phone:301-340-7525
Mailing Address - Fax:301-495-0318
Practice Address - Street 1:7676 NEW HAMPSHIRE AVENUE,
Practice Address - Street 2:SUITE 220 A
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912
Practice Address - Country:US
Practice Address - Phone:301-431-2972
Practice Address - Fax:301-439-0008
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2016-09-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDR218223363LA2200X
FLARNP9335467363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health