Healthcare Provider Details

I. General information

NPI: 1104550995
Provider Name (Legal Business Name): FAITH TINGLE NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 BARBIZON DR
GOSHEN KY
40026-7707
US

IV. Provider business mailing address

1002 BARBIZON DR
GOSHEN KY
40026-7707
US

V. Phone/Fax

Practice location:
  • Phone: 502-259-8845
  • Fax:
Mailing address:
  • Phone: 502-259-8845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number3018049
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: