Healthcare Provider Details

I. General information

NPI: 1205336682
Provider Name (Legal Business Name): TIFFANY HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 02/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE ST RHOADS 3
PHILADELPHIA PA
19104-4238
US

IV. Provider business mailing address

3400 SPRUCE ST RHOADS 3
PHILADELPHIA PA
19104-4238
US

V. Phone/Fax

Practice location:
  • Phone: 215-615-0063
  • Fax: 215-349-8144
Mailing address:
  • Phone: 215-615-0063
  • Fax: 215-349-8144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberSP018224
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: