Healthcare Provider Details

I. General information

NPI: 1568803930
Provider Name (Legal Business Name): TIFFANY ENTREKIN MCMILLAN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2013
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 BROOKWOOD MEDICAL CTR DR
BIRMINGHAM AL
35209-6804
US

IV. Provider business mailing address

2208 JACOBS RD
VESTAVIA AL
35216-2525
US

V. Phone/Fax

Practice location:
  • Phone: 205-547-4848
  • Fax:
Mailing address:
  • Phone: 205-919-1703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number11024858
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number1-126132
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: