Provider Demographics
NPI:1861208670
Name:KIMBLE, TIFFANY LYNN (APN)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LYNN
Last Name:KIMBLE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BYPASS RD STE 104
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NJ
Mailing Address - Zip Code:08079-2053
Mailing Address - Country:US
Mailing Address - Phone:856-887-3005
Mailing Address - Fax:856-753-4035
Practice Address - Street 1:4 BYPASS RD STE 104
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NJ
Practice Address - Zip Code:08079-2053
Practice Address - Country:US
Practice Address - Phone:856-887-3005
Practice Address - Fax:856-753-4035
Is Sole Proprietor?:No
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15227900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily