Healthcare Provider Details

I. General information

NPI: 1487309415
Provider Name (Legal Business Name): TIFFANY MEYER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2022
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W MAPLE ST
FARMINGTON NM
87401-5630
US

IV. Provider business mailing address

500 WESTOVER DR # 14937
SANFORD NC
27330-8941
US

V. Phone/Fax

Practice location:
  • Phone: 505-609-2000
  • Fax:
Mailing address:
  • Phone: 904-982-1851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN9408616
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1073553
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number69365
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: