Individual
TIFFANY L BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
12502 WILLOWBROOK RD STE 380, CUMBERLAND, MD 21502-6592
(240) 964-8585
(240) 964-8586
Mailing address
PO BOX 1671, CUMBERLAND, MD 21501-1671
(240) 964-8585
(240) 964-8586
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R163851
MD
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
R163851
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R163851
MARYLAND BOARD OF NURSING
MD
Enumeration date
09/12/2016
Last updated
01/31/2022
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