Individual
TIFFANY A LONGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9550 W 167TH ST, ORLAND PARK, IL 60467-5561
(708) 873-4500
(708) 873-4505
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
(847) 390-7590
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085002118
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085-002118
ILLINOIS STATE LICENSE
IL
Enumeration date
09/20/2006
Last updated
06/06/2025
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