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General NPI Number Information
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NPI Number | 1063943173
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Entity Type | Individual
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Provider Name | TIFFANY CHANCE
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Gender | Female
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Dates
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Enumeration Date | 03/22/2017
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Last Update Date | 06/09/2026
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Provider Practice Location Address
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Address Line | 52D MEDICAL GROUP 550 RED CROSS LP
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City | APO
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State | AE
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Zip | 09126
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Country | US
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Telephone | 314-452-3167
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Fax |
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Provider Business Mailing Address
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Address Line | PSC 9 BOX 4462
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City | APO
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State | AE
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Zip | 09123-0045
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | APRN-2243
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | APRN-2243
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License Number State | HI
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