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General NPI Number Information
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NPI Number | 1194244053
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Entity Type | Individual
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Provider Name | TIFFANY LYNN MCINTYRE NP-C
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Gender | Female
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Dates
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Enumeration Date | 09/12/2017
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 5123 W 98TH ST # 2082
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City | BLOOMINGTON
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State | MN
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Zip | 55437-2040
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Country | US
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Telephone | 337-991-9276
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Fax |
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Provider Business Mailing Address
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Address Line | 530 US HIGHWAY 12
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City | WILSON
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State | WI
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Zip | 54027-3940
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Country | US
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Telephone | 651-269-9716
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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 | AG08170049
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5486
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 10661-33
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License Number State | WI
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