Basic Information
| Provider Information | |||||||||
| NPI: | 1033703640 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CASIMIRO | ||||||||
| FirstName: | TIFFANY | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MSN, CRNP, WHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 NORTH ST | ||||||||
| Address2: | |||||||||
| City: | HANOVER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 173312275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176377755 | ||||||||
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| Practice Location | |||||||||
| Address1: | 20 NORTH ST | ||||||||
| Address2: | |||||||||
| City: | HANOVER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 173312275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176377755 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2021 | ||||||||
| LastUpdateDate: | 06/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LX0001X | SP022502 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology | 363LW0102X | SP022502 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No ID Information.