Healthcare Provider Details

I. General information

NPI: 1386556934
Provider Name (Legal Business Name): TIFFANY TATIANA SMITH AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIFFANY T LABAS APRN

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 1ST ST
MINEOLA NY
11501-3957
US

IV. Provider business mailing address

240 FULTON ST
WEST BABYLON NY
11704-2039
US

V. Phone/Fax

Practice location:
  • Phone: 516-663-2388
  • Fax:
Mailing address:
  • Phone: 631-645-5334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number433521
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: