Provider Demographics
NPI:1033703640
Name:LOPEZ, TIFFANY D (MSN, CRNP, WHNP-BC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:D
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MSN, CRNP, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 UPPER CHESAPEAKE DR STE 301
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4375
Mailing Address - Country:US
Mailing Address - Phone:443-643-4300
Mailing Address - Fax:
Practice Address - Street 1:520 UPPER CHESAPEAKE DR STE 301
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4375
Practice Address - Country:US
Practice Address - Phone:443-643-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022502363LX0001X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology