Healthcare Provider Details

I. General information

NPI: 1669137832
Provider Name (Legal Business Name): TIFFANY MARIE NAVRKAL NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2021
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 DUFF AVE
AMES IA
50010-5469
US

IV. Provider business mailing address

1215 DUFF AVE
AMES IA
50010-5469
US

V. Phone/Fax

Practice location:
  • Phone: 515-239-4482
  • Fax: 515-239-4732
Mailing address:
  • Phone: 515-239-4482
  • Fax: 515-239-4732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA166302
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: