Healthcare Provider Details

I. General information

NPI: 1437805587
Provider Name (Legal Business Name): TIFFANY BURKE LMT, DOULA, CBE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2022
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4809 W BRADDOCK RD APT 100
ALEXANDRIA VA
22311-4809
US

IV. Provider business mailing address

4809 W BRADDOCK RD APT 100
ALEXANDRIA VA
22311-4809
US

V. Phone/Fax

Practice location:
  • Phone: 571-666-0555
  • Fax:
Mailing address:
  • Phone: 571-666-0555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019018519
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: