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General NPI Number Information
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NPI Number | 1639719230
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Entity Type | Individual
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Provider Name | TIFFANY REED TATE-WOODARD AGNP
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Gender | Female
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Dates
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Enumeration Date | 01/10/2020
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Last Update Date | 01/08/2026
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Provider Practice Location Address
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Address Line | 2420 STATE ST
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City | EAST SAINT LOUIS
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State | IL
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Zip | 62205-2321
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Country | US
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Telephone | 618-318-8809
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Fax | 618-615-4205
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Provider Business Mailing Address
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Address Line | PO BOX 746715
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City | ATLANTA
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State | GA
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Zip | 30374-6715
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Country | US
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Telephone | 618-318-8809
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Fax | 618-615-4205
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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 | 209.026757
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License Number State | IL
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