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NPI Code Detail

MEDICARE: TIFFANY LYNNE BOAN FNP

MEDICARE: TIFFANY LYNNE BOAN FNP
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
1363L00000XNurse Practitioner5000948NC

General Provider Information

NPI Number : 1780672451
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANY LYNNE BOAN FNP
Provider Business Mailing Address
First Line : PO BOX 19305
Second Line :
City : CHARLOTTE
State : NC
Zip : 28219-9305
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8560 COOK ST
Second Line :
City : MOUNT PLEASANT
State : NC
Zip : 28124-7686
Country : US
Telephone Number : 704-436-6521
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/07/2005
Last Update Date : 07/15/2024

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