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General NPI Number Information
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NPI Number | 1598236762
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Entity Type | Individual
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Provider Name | TIFFANY SUBER NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 12/16/2018
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Last Update Date | 12/16/2018
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Provider Practice Location Address
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Address Line | 3803 N ELM ST
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City | GREENSBORO
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State | NC
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Zip | 27455-2593
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Country | US
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Telephone | 617-416-0747
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Fax |
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Provider Business Mailing Address
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Address Line | 14104 BRAMBOROUGH RD
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-3723
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Country | US
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Telephone | 704-280-3219
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 2018073445
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License Number State | NC
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