# TIFFANY DOUGLAS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629448964
- **Authorized official:** TIFFANY DOUGLAS (FNP/ PRIMARY CARE PROVIDER)
- **Authorized official phone:** (864) 423-3561

## Contact information

- **Practice address:** 1 SOLDIERS FIELD PARK, APT 501, BOSTON, MA 02163-1722
- **Practice address phone:** (864) 423-3561
- **Mailing address:** 1 SOLDIERS FIELD PARK, APT 501, BOSTON, MA 02163-1722
- **Mailing address phone:** (864) 423-3561

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | RN2299504 | MA | Yes |

## Other

- **Enumeration date:** 09/29/2015
- **Last updated:** 09/29/2015