Healthcare Provider Details

I. General information

NPI: 1700505773
Provider Name (Legal Business Name): TIFFANY D YEARGAN CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3234 MILLER AVE
CROSSVILLE TN
38555-6116
US

IV. Provider business mailing address

3234 MILLER AVE
CROSSVILLE TN
38555-6116
US

V. Phone/Fax

Practice location:
  • Phone: 931-707-8700
  • Fax: 931-456-0802
Mailing address:
  • Phone: 931-707-8700
  • Fax: 931-456-0802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number32143
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: