Provider Demographics
NPI:1386450187
Name:HENRY, TIFFANY LEIGH (RN)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LEIGH
Last Name:HENRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 THREE CHOPT RD
Mailing Address - Street 2:
Mailing Address - City:GUM SPRING
Mailing Address - State:VA
Mailing Address - Zip Code:23065-2030
Mailing Address - Country:US
Mailing Address - Phone:540-967-7101
Mailing Address - Fax:
Practice Address - Street 1:601 WATKINS CENTRE PKWY
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-0002
Practice Address - Country:US
Practice Address - Phone:804-893-8440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001280829163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency