Provider Demographics
NPI:1538556642
Name:HEALY, TIFFANY A (APRN-RX)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:A
Last Name:HEALY
Suffix:
Gender:F
Credentials:APRN-RX
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:ANN
Other - Last Name:HEALY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FAMILY PSYCH NP
Mailing Address - Street 1:PO BOX 1220
Mailing Address - Street 2:
Mailing Address - City:KEALAKEKUA
Mailing Address - State:HI
Mailing Address - Zip Code:96750-1220
Mailing Address - Country:US
Mailing Address - Phone:808-896-6369
Mailing Address - Fax:
Practice Address - Street 1:81-6360 MAMALAHOA HWY # 2
Practice Address - Street 2:
Practice Address - City:KEALAKEKUA
Practice Address - State:HI
Practice Address - Zip Code:96750-8132
Practice Address - Country:US
Practice Address - Phone:808-896-6369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-16
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-2616363LP0808X
HIRN-69912163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health