MEDICARE: TIFFANY E. CHAMBERS NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	333497	GA
2	363LP2300X	Primary Care Nurse Practitioner	333497	GA
3	363LA2200X	Adult Health Nurse Practitioner	0039531	OH
4	363LG0600X	Gerontology Nurse Practitioner	333497	GA

General Provider Information

NPI Number	:	1023826393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY E. CHAMBERS NP

Provider Business Mailing Address
First Line	:	PO BOX 1200
Second Line	:
City	:	PLEASANT GROVE
State	:	UT
Zip	:	84062-1200
Country	:	US
Telephone Number	:	800-640-3451
Fax Number	:

Provider Business Practice Location Address
First Line	:	2460 FAIRMOUNT BLVD STE B
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44106-3177
Country	:	US
Telephone Number	:	800-640-3451
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2024
Last Update Date	:	02/03/2026

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