Healthcare Provider Details

I. General information

NPI: 1649995234
Provider Name (Legal Business Name): SARAH TINGLE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2022
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 LEIGH DR
COLUMBUS MS
39705-3014
US

IV. Provider business mailing address

670 LEIGH DR
COLUMBUS MS
39705-3014
US

V. Phone/Fax

Practice location:
  • Phone: 662-328-1012
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number905526
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: