Provider Demographics
NPI:1861124588
Name:RAIKES, TIFFANY EILEEN (FNP-C)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:EILEEN
Last Name:RAIKES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 SOUTHPARK BLVD
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-3609
Mailing Address - Country:US
Mailing Address - Phone:804-504-7980
Mailing Address - Fax:804-554-5387
Practice Address - Street 1:524 SOUTHPARK BLVD
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-3609
Practice Address - Country:US
Practice Address - Phone:804-504-7980
Practice Address - Fax:804-554-5387
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024184519363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily