Provider Demographics
NPI:1487379657
Name:KESHWAH, TIFFANY (CPNP-AC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:KESHWAH
Suffix:
Gender:F
Credentials:CPNP-AC
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPNP-AC
Mailing Address - Street 1:119 KINGBIRD CT
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-1273
Mailing Address - Country:US
Mailing Address - Phone:912-659-3276
Mailing Address - Fax:
Practice Address - Street 1:4700 WATERS AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6220
Practice Address - Country:US
Practice Address - Phone:912-350-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN219748363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics