Healthcare Provider Details

I. General information

NPI: 1477265635
Provider Name (Legal Business Name): TIFFANY VILLAMARIN AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2022
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 WESTCHESTER AVE
WEST HARRISON NY
10604-3200
US

IV. Provider business mailing address

34 MAPLE ST
NORWALK CT
06850-3815
US

V. Phone/Fax

Practice location:
  • Phone: 914-540-5593
  • Fax:
Mailing address:
  • Phone: 475-296-5211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF310820-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number11560
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: