Healthcare Provider Details

I. General information

NPI: 1003262981
Provider Name (Legal Business Name): TIFFANY OGUNYEMI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIFFANY PARKER

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

959 QUAIL LAKE CIR APT 202
COLORADO SPRINGS CO
80906-4605
US

IV. Provider business mailing address

410 PIPING ROCK DR
SILVER SPRING MD
20905-5652
US

V. Phone/Fax

Practice location:
  • Phone: 931-215-8314
  • Fax:
Mailing address:
  • Phone: 931-215-8314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR094961
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0992536
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAC002559
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: