Provider Demographics
NPI:1447096185
Name:QUINN, TIFFANY M (AGPCNP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:M
Last Name:QUINN
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 S PALISADE DR STE 210
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-8906
Mailing Address - Country:US
Mailing Address - Phone:805-934-2488
Mailing Address - Fax:805-934-2480
Practice Address - Street 1:116 S PALISADE DR STE 210
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-8906
Practice Address - Country:US
Practice Address - Phone:805-934-2488
Practice Address - Fax:805-934-2480
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95031538363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health