1104911544 NPI number — DR. TIFFANY NIGHTENGALE DMD

Table of content: DR. TIFFANY NIGHTENGALE DMD (NPI 1104911544)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104911544 NPI number — DR. TIFFANY NIGHTENGALE DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NIGHTENGALE
Provider First Name:
TIFFANY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104911544
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20280 MARKET ST
Provider Second Line Business Mailing Address:
9434 HOSPITAL AVE
Provider Business Mailing Address City Name:
ONANCOCK
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23417-1331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-414-0400
Provider Business Mailing Address Fax Number:
757-414-0569

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5219 LANKFORD HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW CHURCH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23415-3332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-824-5676
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/03/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  0401411539 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223G0001X , with the licence number: 12011047A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9183551 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".