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General NPI Number Information
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NPI Number | 1861990780
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Entity Type | Individual
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Provider Name | TIFFANY TOMIYE ROBERTS FNP-C
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Gender | Female
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Dates
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Enumeration Date | 01/25/2018
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Last Update Date | 12/06/2023
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Provider Practice Location Address
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Address Line | 34980 LAHAINA LOOP RD
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City | CLOVERDALE
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State | OR
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Zip | 97112-9112
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Country | US
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Telephone | 503-310-3582
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 427
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City | PACIFIC CITY
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State | OR
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Zip | 97135-0427
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Country | US
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Telephone | 503-310-3582
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 10004660
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5010214
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License Number State | NC
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