Healthcare Provider Details

I. General information

NPI: 1013470194
Provider Name (Legal Business Name): TIFFANY MICHELLE LUONGO FNP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIFFANY MICHELLE PAOLILLO FNP, RN

II. Dates (important events)

Enumeration Date: 04/07/2019
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 WHITE ST
CAMBRIDGE MA
02140-1449
US

IV. Provider business mailing address

36 WHITE STREET
CAMBRIDGE MA
02140-1449
US

V. Phone/Fax

Practice location:
  • Phone: 617-876-5519
  • Fax:
Mailing address:
  • Phone: 617-876-5519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2289065
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2289065
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number116074-21
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLG-0013587
License Number StateDE
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11043606
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0040823
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number116074-21
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: