Healthcare Provider Details

I. General information

NPI: 1205452471
Provider Name (Legal Business Name): TIFFANY PADGETT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 ALLEN CT
NORTH AUGUSTA SC
29860-9782
US

IV. Provider business mailing address

130 ALLEN CT
NORTH AUGUSTA SC
29860-9782
US

V. Phone/Fax

Practice location:
  • Phone: 803-279-7666
  • Fax: 803-279-0708
Mailing address:
  • Phone: 803-279-7666
  • Fax: 803-279-0708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number24000
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: