Healthcare Provider Details

I. General information

NPI: 1750959920
Provider Name (Legal Business Name): TIFFANY AMBER HESLOP NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TIFFANY AMBER HENRY

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 WASHINGTON ST
HARTFORD CT
06106-3322
US

IV. Provider business mailing address

391 MYRTLE AVE STE 1A
ALBANY NY
12208-3797
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-9200
  • Fax: 860-545-9134
Mailing address:
  • Phone: 518-262-1700
  • Fax: 518-262-9985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number383244
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number11369
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: