Healthcare Provider Details

I. General information

NPI: 1912839176
Provider Name (Legal Business Name): TIFFANY AMANDA WHITE DNP, RN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 MIDLAND RD STE A
SOUTHERN PINES NC
28387-3300
US

IV. Provider business mailing address

295 BIBEY RD
CARTHAGE NC
28327-7227
US

V. Phone/Fax

Practice location:
  • Phone: 910-639-5591
  • Fax:
Mailing address:
  • Phone: 910-639-3673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number278547
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: