Healthcare Provider Details

I. General information

NPI: 1962919209
Provider Name (Legal Business Name): TIFFANY NICOLE SPENCER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 DARLINGTON DR
AIKEN SC
29803-8542
US

IV. Provider business mailing address

336 GEORGIA AVE STE 106
NORTH AUGUSTA SC
29841-3887
US

V. Phone/Fax

Practice location:
  • Phone: 803-380-7000
  • Fax:
Mailing address:
  • Phone: 803-509-4729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number21547
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number21547
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number21547
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: