Healthcare Provider Details

I. General information

NPI: 1669179370
Provider Name (Legal Business Name): TIFFANY T ANDRUSKE PNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14557 US-19 STE A
GRIFFIN GA
30224
US

IV. Provider business mailing address

14557 IS-19 STE A
GRIFFIN GA
30224
US

V. Phone/Fax

Practice location:
  • Phone: 404-788-4701
  • Fax:
Mailing address:
  • Phone: 678-688-1580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN213276
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: