Provider Demographics
NPI:1346072154
Name:SPEICHER, TIFFANI ANGELICA WEBB (NP-BC)
Entity type:Individual
Prefix:
First Name:TIFFANI ANGELICA
Middle Name:WEBB
Last Name:SPEICHER
Suffix:
Gender:F
Credentials:NP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1556 N D ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92405-4710
Mailing Address - Country:US
Mailing Address - Phone:909-885-0652
Mailing Address - Fax:
Practice Address - Street 1:1556 N D ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92405-4710
Practice Address - Country:US
Practice Address - Phone:909-885-0652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028064363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily