Healthcare Provider Details

I. General information

NPI: 1306242573
Provider Name (Legal Business Name): TIFFANY ANN TOLBERT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2014
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 WILLOW CREEK DR
SPRINGDALE AR
72762-8711
US

IV. Provider business mailing address

3531 S MARION AVE
TULSA OK
74135-4508
US

V. Phone/Fax

Practice location:
  • Phone: 479-684-3104
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number102773
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number230148
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: