Provider Demographics
NPI:1205433802
Name:ZELLERS, TIFFIN MARIE (DNP)
Entity type:Individual
Prefix:
First Name:TIFFIN
Middle Name:MARIE
Last Name:ZELLERS
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 N ORCHARD
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-3232
Mailing Address - Country:US
Mailing Address - Phone:505-927-0157
Mailing Address - Fax:
Practice Address - Street 1:1308 N ORCHARD
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-3232
Practice Address - Country:US
Practice Address - Phone:505-927-0157
Practice Address - Fax:855-928-4040
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2022-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM60817363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health