TIFFANY DOUGLAS
NPI 1629448964
Clinic/Center in Boston, MA

Active since September 29, 2015
1 SOLDIERS FIELD PARK, APT 501, BOSTON, MA 02163(864) 423-3561 Get Directions Write a Review

NPPES record last updated: September 29, 2015. Verified against the NPPES registry weekly; last sync: July 19, 2026.

  • Organization
  • Clinic/Center

About TIFFANY DOUGLAS

This page provides the complete NPI Profile along with additional information for Tiffany Douglas, a provider established in Boston, Massachusetts operating as a Clinic/center. The healthcare provider is registered in the NPI registry with number 1629448964 assigned on September 2015. The practitioner's primary taxonomy code is 261Q00000X with license number RN2299504 (MA). The provider is registered as an organization and their NPI record was last updated 11 years ago. The authorized official of this NPI record is Tiffany Douglas (Fnp/ Primary Care Provider)

NPI
1629448964 Verify this NPI
Provider Name
TIFFANY DOUGLAS
Entity Type
Organization
Location Address
1 SOLDIERS FIELD PARK APT 501 BOSTON, MA 02163
Location Phone
(864) 423-3561
Mailing Address
1 SOLDIERS FIELD PARK APT 501 BOSTON, MA 02163
Mailing Phone
(864) 423-3561
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
09-29-2015
Last Update Date
09-29-2015
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Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Clinic/Center

Taxonomy Code
261Q00000X
Type
Ambulatory Health Care Facilities
License No.
RN2299504
License State
MA
Taxonomy Description
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

TIFFANY DOUGLAS

Authorized Official Title
FNP/ PRIMARY CARE PROVIDER
Authorized Official Phone
(864) 423-3561

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Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1629448964, enumerated as an "organization" on September 29, 2015.

The provider is located at 1 SOLDIERS FIELD PARK APT 501 BOSTON, MA 02163 and the phone number is (864) 423-3561.

Clinic/Center with taxonomy code 261Q00000X.