MEDICARE: KARA TIFFAN CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN11038876	FL
2	163W00000X	Registered Nurse	RN.403618	OH
3	363LF0000X	Family Nurse Practitioner	APRN.CNP.0028689	OH
4	163W00000X	Registered Nurse	28296393A	IN
5	363LF0000X	Family Nurse Practitioner	334952	AZ

General Provider Information

NPI Number	:	1659005502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARA TIFFAN CNP

Provider Business Mailing Address
First Line	:	1460 BROADWAY
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10036-7329
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1460 BROADWAY
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10036-7329
Country	:	US
Telephone Number	:	888-623-3195
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2022
Last Update Date	:	04/09/2026

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