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General NPI Number Information
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NPI Number | 1386556934
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Entity Type | Individual
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Provider Name | TIFFANY TATIANA SMITH AGACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/18/2026
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Last Update Date | 09/18/2026
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Provider Practice Location Address
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Address Line | 259 1ST ST
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City | MINEOLA
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State | NY
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Zip | 11501-3957
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Country | US
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Telephone | 516-663-2388
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Fax |
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Provider Business Mailing Address
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Address Line | 240 FULTON ST
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City | WEST BABYLON
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State | NY
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Zip | 11704-2039
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Country | US
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Telephone | 631-645-5334
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 433521
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License Number State | NY
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