Healthcare Provider Details

I. General information

NPI: 1467380626
Provider Name (Legal Business Name): TIFFANY ANIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 N MIDLAND AVE
NYACK NY
10960-1912
US

IV. Provider business mailing address

393 AVALON GARDENS DR
NANUET NY
10954-7430
US

V. Phone/Fax

Practice location:
  • Phone: 845-348-2565
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF40874701
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number828714
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: