Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 95007007 | CA |
NPI | 1013434158 |
---|---|
Provider Name | Tiffanie Sims |
First Address | Merced, CA 95344-3768 |
Second Address | Merced, CA 95340-1001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2017 |
Last Update Date | 29/08/2017 |