Provider Demographics
NPI:1053392373
Name:REABOLD, TIFFANY D (CRNP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:D
Last Name:REABOLD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:D
Other - Last Name:SHELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2231
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-851-6969
Practice Address - Street 1:250 W BROADWAY
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-1200
Practice Address - Country:US
Practice Address - Phone:717-337-4105
Practice Address - Fax:717-798-3407
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR137035363L00000X, 363LF0000X
PASP030802363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
H828Medicare ID - Type Unspecified