Provider Demographics
NPI:1396507323
Name:ELIAS, TIFFANY (CNM)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:ELIAS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 SUNDANCE DR
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-7053
Mailing Address - Country:US
Mailing Address - Phone:402-239-0514
Mailing Address - Fax:
Practice Address - Street 1:175 SUNDANCE DR
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-7053
Practice Address - Country:US
Practice Address - Phone:402-239-0514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-25
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95265503163W00000X
CA367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse