MEDICARE: TIFFANY J FORSTER APRN-CNP

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	363L00000X	Nurse Practitioner	92024	OK

General Provider Information

NPI Number	:	1245877760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY J FORSTER APRN-CNP

Provider Business Mailing Address
First Line	:	219 E COMMERCE ST
Second Line	:
City	:	ALTUS
State	:	OK
Zip	:	73521-3913
Country	:	US
Telephone Number	:	580-563-0454
Fax Number	:	580-603-8602

Provider Business Practice Location Address
First Line	:	219 E COMMERCE ST
Second Line	:
City	:	ALTUS
State	:	OK
Zip	:	73521-3913
Country	:	US
Telephone Number	:	580-563-0454
Fax Number	:	580-603-8602

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

Provider Enumeration Date	:	12/03/2019
Last Update Date	:	12/06/2025

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