Healthcare Provider Details

I. General information

NPI: 1477204006
Provider Name (Legal Business Name): TIFFANY ANN GILLARD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2022
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W EVANS ST STE 107
FLORENCE SC
29501-3801
US

IV. Provider business mailing address

5117 S HIGHWAY 41
MARION SC
29571-8379
US

V. Phone/Fax

Practice location:
  • Phone: 888-918-2415
  • Fax:
Mailing address:
  • Phone: 843-229-9281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number25797
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF09211444
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: