Healthcare Provider Details

I. General information

NPI: 1972842359
Provider Name (Legal Business Name): TIFFANY J NELSON NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2013
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8033 W FLORISSANT AVE STE A
JENNINGS MO
63136-1412
US

IV. Provider business mailing address

PO BOX 740019
ATLANTA GA
30374-0019
US

V. Phone/Fax

Practice location:
  • Phone: 314-888-0971
  • Fax: 314-408-7062
Mailing address:
  • Phone: 833-804-1695
  • Fax: 312-929-0373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2012022140
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: