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General NPI Number Information
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NPI Number | 1205659562
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Entity Type | Individual
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Provider Name | TIFFANY MIKE NP
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Gender | Female
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Dates
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Enumeration Date | 11/05/2024
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 2300 DAWSON RD
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City | ALBANY
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State | GA
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Zip | 31707-2803
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Country | US
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Telephone | 229-436-8535
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Fax |
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Provider Business Mailing Address
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Address Line | 98 PALMETTA RD
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City | TIFTON
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State | GA
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Zip | 31793-8369
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Country | US
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Telephone | 229-848-3442
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | RN146927
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License Number State | GA
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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 | RN146927
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License Number State | GA
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