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General NPI Number Information
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NPI Number | 1164063962
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Entity Type | Individual
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Provider Name | TIFFANY N GODFREY APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 10/02/2019
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Last Update Date | 04/27/2022
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Provider Practice Location Address
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Address Line | 2015 JACKSON ST
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City | ANDERSON
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State | IN
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Zip | 46016-4337
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Country | US
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Telephone | 765-646-2511
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Fax |
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Provider Business Mailing Address
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Address Line | 3024 COUNTRY ESTATES DR
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City | NEW CASTLE
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State | IN
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Zip | 47362-5107
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Country | US
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Telephone | 765-524-3589
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN.CNP.0000074
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 28184427A
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License Number State | IN
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