Provider Demographics
NPI:1548865025
Name:PENDLETON, TIFFANI CHEREE (NP-C)
Entity type:Individual
Prefix:MRS
First Name:TIFFANI
Middle Name:CHEREE
Last Name:PENDLETON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17507 TREE VIEW CT
Mailing Address - Street 2:
Mailing Address - City:MOSELEY
Mailing Address - State:VA
Mailing Address - Zip Code:23120-2257
Mailing Address - Country:US
Mailing Address - Phone:240-538-8624
Mailing Address - Fax:
Practice Address - Street 1:17507 TREE VIEW CT
Practice Address - Street 2:
Practice Address - City:MOSELEY
Practice Address - State:VA
Practice Address - Zip Code:23120-2257
Practice Address - Country:US
Practice Address - Phone:240-538-8624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024180118363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily