Healthcare Provider Details

I. General information

NPI: 1528339678
Provider Name (Legal Business Name): CLIFFORD LOUIS HUFFMAN JR. FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2012
Last Update Date: 02/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 COLLEGE ST
MONTEAGLE TN
37356-7005
US

IV. Provider business mailing address

215 COLLEGE ST
MONTEAGLE TN
37356-7005
US

V. Phone/Fax

Practice location:
  • Phone: 931-924-6222
  • Fax: 949-862-4433
Mailing address:
  • Phone: 931-924-6222
  • Fax: 949-862-4433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15897
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: