Healthcare Provider Details

I. General information

NPI: 1457682155
Provider Name (Legal Business Name): TIFFANY BARNES RN, MSN, PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2010
Last Update Date: 10/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PIERCE ST 2ND FLOOR
SAN FRANCISCO CA
94115-4005
US

IV. Provider business mailing address

1301 PIERCE ST 2ND FLOOR
SAN FRANCISCO CA
94115-4640
US

V. Phone/Fax

Practice location:
  • Phone: 925-313-6986
  • Fax: 925-313-6188
Mailing address:
  • Phone: 925-313-6986
  • Fax: 925-313-6188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number675485
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number2717
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: