Provider Demographics
NPI:1407742026
Name:SANTOS, TIFFANI MARIE (FNP-C)
Entity type:Individual
Prefix:
First Name:TIFFANI
Middle Name:MARIE
Last Name:SANTOS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3754 N NOTTINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-2230
Mailing Address - Country:US
Mailing Address - Phone:773-691-0520
Mailing Address - Fax:
Practice Address - Street 1:3754 N NOTTINGHAM AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-2230
Practice Address - Country:US
Practice Address - Phone:773-691-0520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209032154363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily