Healthcare Provider Details

I. General information

NPI: 1023813219
Provider Name (Legal Business Name): TIFFANY G ROCK AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 S 17TH ST
WILMINGTON NC
28401-7407
US

IV. Provider business mailing address

3923 MERESTONE DR
WILMINGTON NC
28412-5185
US

V. Phone/Fax

Practice location:
  • Phone: 910-667-6001
  • Fax: 910-815-5086
Mailing address:
  • Phone: 678-852-6948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number5021668
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: