Individual
TIFFANY E POLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1041 SHARON RD, SUITE 205, KING WILLIAM, VA 23086-3347
(804) 746-1677
(804) 769-3170
Mailing address
1041 SHARON RD, SUITE 205, KING WILLIAM, VA 23086-3347
(804) 746-1677
(804) 769-3170
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
0024172717
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C05698
GROUP PTAN
VA
Enumeration date
06/02/2015
Last updated
07/16/2015
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