Healthcare Provider Details

I. General information

NPI: 1457820334
Provider Name (Legal Business Name): TIFFANY SUSAN MILLETT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2018
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 COURT DR
GASTONIA NC
28054-2151
US

IV. Provider business mailing address

2315 COURT DR
GASTONIA NC
28054-2151
US

V. Phone/Fax

Practice location:
  • Phone: 704-671-5343
  • Fax: 704-671-5308
Mailing address:
  • Phone: 704-671-5343
  • Fax: 704-671-5308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number291905
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number59613
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5024705
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: