Healthcare Provider Details

I. General information

NPI: 1447972740
Provider Name (Legal Business Name): TIFFANY JANINE OCHOA FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3336 COUNTRY CLUB RD
BRONX NY
10465-1254
US

IV. Provider business mailing address

3336 COUNTRY CLUB RD
BRONX NY
10465-1254
US

V. Phone/Fax

Practice location:
  • Phone: 347-557-2929
  • Fax:
Mailing address:
  • Phone: 347-557-2929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number347483
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: