Healthcare Provider Details

I. General information

NPI: 1265613442
Provider Name (Legal Business Name): TIFFANY LEE ROWE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2007
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 YARKERDALE DR
ROCHESTER NY
14615-1033
US

IV. Provider business mailing address

55 YARKERDALE DR
ROCHESTER NY
14615-1033
US

V. Phone/Fax

Practice location:
  • Phone: 315-515-1553
  • Fax:
Mailing address:
  • Phone: 315-515-1553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number310449
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number281638
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: