Healthcare Provider Details

I. General information

NPI: 1629399506
Provider Name (Legal Business Name): TIFFANY SMILEY MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2010
Last Update Date: 04/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 BROADWAY MS HB-1
GARY IN
46402-1221
US

IV. Provider business mailing address

215 BROADWAY MS HB-1
GARY IN
46402-1221
US

V. Phone/Fax

Practice location:
  • Phone: 219-888-4221
  • Fax: 219-888-5022
Mailing address:
  • Phone: 219-888-4221
  • Fax: 219-888-5022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71003278A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: