Healthcare Provider Details

I. General information

NPI: 1528742582
Provider Name (Legal Business Name): TIFFANY MICHELLE GRECO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 07/16/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 FIRST VILLAGE DR
PINEHURST NC
28374-9495
US

IV. Provider business mailing address

310 SOUTH ST
VASS NC
28394-1009
US

V. Phone/Fax

Practice location:
  • Phone: 910-295-0290
  • Fax: 910-295-0876
Mailing address:
  • Phone: 256-608-0149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number5019634
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: