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NPI Code Detail

MEDICARE: TIFFANY A GONZALO CRNP

MEDICARE: TIFFANY A GONZALO CRNP
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
1363LF0000XFamily Nurse Practitioner0024185508VA
2363LF0000XFamily Nurse PractitionerSP011520PA
3363L00000XNurse Practitioner0024185508VA

General Provider Information

NPI Number : 1700167822
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANY A GONZALO CRNP
Provider Business Mailing Address
First Line : 213 S JEFFERSON ST STE 1006
Second Line :
City : ROANOKE
State : VA
Zip : 24011-1713
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4035 ELECTRIC RD STE B
Second Line :
City : ROANOKE
State : VA
Zip : 24018-8449
Country : US
Telephone Number : 540-767-0380
Fax Number : 540-772-2370
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2011
Last Update Date : 12/18/2025

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1922336452 — MS. JENICE DIANE PALACHICK CRNP
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1861792400 — BRANDI L. TOMLIN RN
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1790072254 — MS. ASHLEY ROSE DUDDEN CRNP
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Directions to “ TIFFANY A GONZALO CRNP” Practice Location

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