Provider Demographics
NPI:1962227751
Name:WHITESIDE, TIFFANY
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:WHITESIDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:563 EAST FRONT STREET
Mailing Address - Street 2:APT B
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07062-0706
Mailing Address - Country:US
Mailing Address - Phone:908-265-4101
Mailing Address - Fax:330-849-0344
Practice Address - Street 1:563 EAST FRONT STREET
Practice Address - Street 2:APT B
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07062
Practice Address - Country:US
Practice Address - Phone:908-265-4101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator