Healthcare Provider Details

I. General information

NPI: 1265380596
Provider Name (Legal Business Name): TIFFANY LASHELLE TAYLOR SFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12173 MAIN ST STE B
MASON TN
38049-7067
US

IV. Provider business mailing address

135 TEALWOOD CV
ATOKA TN
38004-7902
US

V. Phone/Fax

Practice location:
  • Phone: 901-403-8432
  • Fax:
Mailing address:
  • Phone: 901-613-9787
  • Fax: 901-446-3339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number41658
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: