Healthcare Provider Details

I. General information

NPI: 1346172509
Provider Name (Legal Business Name): TIFFANY NICOLE VANOVER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 SYLVESTER HWY
ALBANY GA
31705-2479
US

IV. Provider business mailing address

2994 EASY ST
WESTON GA
31832-2504
US

V. Phone/Fax

Practice location:
  • Phone: 229-312-9220
  • Fax: 229-312-9205
Mailing address:
  • Phone: 229-321-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number296951
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: