Provider Demographics
NPI:1134616824
Name:EATON, TIFFANY ANN (FNP)
Entity type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:ANN
Last Name:EATON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 GREENLAW DISTRICT RD
Mailing Address - Street 2:
Mailing Address - City:DEER ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04627-3551
Mailing Address - Country:US
Mailing Address - Phone:207-348-5668
Mailing Address - Fax:207-374-3970
Practice Address - Street 1:57 WATER ST
Practice Address - Street 2:
Practice Address - City:BLUE HILL
Practice Address - State:ME
Practice Address - Zip Code:04614
Practice Address - Country:US
Practice Address - Phone:207-374-3995
Practice Address - Fax:207-374-3970
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP181154363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1134616824Medicaid