=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346172509
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TIFFANY NICOLE VANOVER FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2026
-----------------------------------------------------
Last Update Date | 06/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2410 SYLVESTER HWY
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31705-2479
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-312-9220
-----------------------------------------------------
Fax | 229-312-9205
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2994 EASY ST
-----------------------------------------------------
City | WESTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31832-2504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-321-9355
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 296951
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------