MEDICARE: TIFFANY CONNOR FNP-C

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	29382	SC

General Provider Information

NPI Number	:	1912719105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY CONNOR FNP-C

Provider Business Mailing Address
First Line	:	2550 ELMS CENTER RD
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-9844
Country	:	US
Telephone Number	:	843-302-8840
Fax Number	:

Provider Business Practice Location Address
First Line	:	2550 ELMS CENTER RD
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-9844
Country	:	US
Telephone Number	:	843-302-8840
Fax Number	:

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

Provider Enumeration Date	:	01/23/2025
Last Update Date	:	01/15/2026

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