Healthcare Provider Details

I. General information

NPI: 1447068523
Provider Name (Legal Business Name): TIFFANY LYNN HARBIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11935 ABERCORN ST DEPT 4158
SAVANNAH GA
31419-1918
US

IV. Provider business mailing address

11935 ABERCORN ST DEPT 4158
SAVANNAH GA
31419-1918
US

V. Phone/Fax

Practice location:
  • Phone: 912-344-2585
  • Fax:
Mailing address:
  • Phone: 912-344-2585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN300275
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP300275
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: