Healthcare Provider Details

I. General information

NPI: 1972285674
Provider Name (Legal Business Name): TIFFANNY ROBERTA ROSE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 08/02/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 LOCUST ST
NORTHAMPTON MA
01060-2093
US

IV. Provider business mailing address

40 KEYES ST
FLORENCE MA
01062-1443
US

V. Phone/Fax

Practice location:
  • Phone: 413-582-2000
  • Fax:
Mailing address:
  • Phone: 517-442-7396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2381583
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: