Provider Demographics
NPI:1588906150
Name:ZAMZOW, TIFFANY ANNE (NNP-BC, APNP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANNE
Last Name:ZAMZOW
Suffix:
Gender:F
Credentials:NNP-BC, APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 PORT WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-9201
Mailing Address - Country:US
Mailing Address - Phone:262-329-4900
Mailing Address - Fax:262-329-4901
Practice Address - Street 1:975 PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WI
Practice Address - Zip Code:53024-9201
Practice Address - Country:US
Practice Address - Phone:262-329-4900
Practice Address - Fax:262-329-4901
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5255-033363L00000X
WI5255-33363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1588906150Medicaid
WIK400342197Medicare PIN