Provider Demographics
NPI:1588385892
Name:NIEVES, TIFFANY M (APRN, PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:M
Last Name:NIEVES
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:MS
Other - First Name:TIFFANY
Other - Middle Name:MARIE
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:966 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLANTSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06479-1645
Mailing Address - Country:US
Mailing Address - Phone:860-736-5386
Mailing Address - Fax:
Practice Address - Street 1:966 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PLANTSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06479-1645
Practice Address - Country:US
Practice Address - Phone:860-736-5386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13573363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health