Healthcare Provider Details

I. General information

NPI: 1306343504
Provider Name (Legal Business Name): TIFFANY MICHELLE HAGMANN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 CARLISLE RD
YORK PA
17404-4939
US

IV. Provider business mailing address

PO BOX 746722
ATLANTA GA
30374-6722
US

V. Phone/Fax

Practice location:
  • Phone: 717-200-1567
  • Fax:
Mailing address:
  • Phone: 469-727-6675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP018756
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: