Provider Demographics
NPI:1144530825
Name:REBAR, TIFFANY J (CRNP)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:J
Last Name:REBAR
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MISS
Other - First Name:TIFFANY
Other - Middle Name:J
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:625 N POTTSTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-1628
Mailing Address - Country:US
Mailing Address - Phone:610-903-0640
Mailing Address - Fax:610-903-0637
Practice Address - Street 1:625 N POTTSTOWN PIKE
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1628
Practice Address - Country:US
Practice Address - Phone:610-903-0640
Practice Address - Fax:610-903-0637
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010740363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily