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General NPI Number Information
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NPI Number | 1639095607
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Entity Type | Individual
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Provider Name | TIFFANY MAXFIELD
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Gender | Female
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Dates
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Enumeration Date | 06/25/2026
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Last Update Date | 06/25/2026
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Provider Practice Location Address
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Address Line | 21 HIGHLAND AVE SE STE 100
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City | ROANOKE
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State | VA
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Zip | 24013-2218
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Country | US
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Telephone | 540-982-8881
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Fax |
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Provider Business Mailing Address
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Address Line | 71 ANTIETAM HILL RD
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City | DALEVILLE
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State | VA
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Zip | 24083-3247
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Country | US
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Telephone | 540-816-0460
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 1300452
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License Number State | VA
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