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General NPI Number Information
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NPI Number | 1164081634
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Entity Type | Individual
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Provider Name | TIFFANY FARRELL CRNA
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Gender | Female
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Dates
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Enumeration Date | 06/10/2019
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Last Update Date | 06/10/2019
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Provider Practice Location Address
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Address Line | 320 WHITTINGTON PKWY STE 301
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City | LOUISVILLE
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State | KY
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Zip | 40222-4919
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Country | US
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Telephone | 502-379-1212
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Fax |
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Provider Business Mailing Address
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Address Line | 1214 BLOOM HILL AVE
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City | VALRICO
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State | FL
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Zip | 33596-8119
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Country | US
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Telephone | 919-249-6470
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 126821
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License Number State | FL
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