Provider Demographics
NPI:1487468385
Name:PALMER, TIFFANY RAE (RN)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:RAE
Last Name:PALMER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:RAE
Other - Last Name:MCKINNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1291 HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94542-1043
Mailing Address - Country:US
Mailing Address - Phone:510-305-3543
Mailing Address - Fax:
Practice Address - Street 1:280 EDMONDS RD
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-3813
Practice Address - Country:US
Practice Address - Phone:650-479-9090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95396580163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse