Healthcare Provider Details

I. General information

NPI: 1649686148
Provider Name (Legal Business Name): TIFFANY WOODARD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIFFANY JONES APRN

II. Dates (important events)

Enumeration Date: 07/03/2014
Last Update Date: 10/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 WINDOVER RD
JONESBORO AR
72401-6159
US

IV. Provider business mailing address

PO BOX 1960
JONESBORO AR
72403-1960
US

V. Phone/Fax

Practice location:
  • Phone: 870-935-5432
  • Fax: 870-934-3652
Mailing address:
  • Phone: 870-935-5432
  • Fax: 870-934-3652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA004120
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: