Healthcare Provider Details

I. General information

NPI: 1194051433
Provider Name (Legal Business Name): TIFFANY ANN HUFFMAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2009
Last Update Date: 12/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 S. MAIN
CARL JUNCTION MO
64834
US

IV. Provider business mailing address

PO BOX 3810
JOPLIN MO
64803-3810
US

V. Phone/Fax

Practice location:
  • Phone: 417-347-8656
  • Fax: 417-347-8658
Mailing address:
  • Phone: 417-347-8656
  • Fax: 417-347-8658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2009032381
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: