Individual
TIFFANY AMBER NICKENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
101 WEST COAST RD, #B, REDWAY, CA 95560
(707) 923-2783
Mailing address
8401 CONNECTICUT AVE PH SUITE, CHEVY CHASE, MD 20815-5822
(301) 942-2212
(301) 942-1149
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
62762
CA
Other
Enumeration date
06/01/2018
Last updated
09/23/2025
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