Healthcare Provider Details

I. General information

NPI: 1366103749
Provider Name (Legal Business Name): PURPLE LILY CARE SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2022
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 E MARTINTOWN RD STE 105
NORTH AUGUSTA SC
29841-5312
US

IV. Provider business mailing address

802 E MARTINTOWN RD STE 105
NORTH AUGUSTA SC
29841-5312
US

V. Phone/Fax

Practice location:
  • Phone: 803-508-4729
  • Fax:
Mailing address:
  • Phone: 803-508-4729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TIFFANY NICOLE SPENCER
Title or Position: NP
Credential:
Phone: 803-508-4729