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General NPI Number Information
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NPI Number | 1699350835
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Entity Type | Individual
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Provider Name | TIFFANY MASTIN REGISTERED NURSE
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Gender | Female
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Dates
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Enumeration Date | 03/09/2021
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Last Update Date | 11/18/2021
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Provider Practice Location Address
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Address Line | 2274 SALEM RD SE STE 1061273
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City | CONYERS
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State | GA
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Zip | 30013-2097
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Country | US
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Telephone | 844-286-8232
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Fax |
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Provider Business Mailing Address
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Address Line | 110 ASHTONBROOK DR
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City | MCDONOUGH
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State | GA
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Zip | 30252-6705
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Country | US
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Telephone | 404-922-1985
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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 | 163WC1600X
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Taxonomy Name | Continuing Education/Staff Development Registered Nurse
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License Number | RN289185
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | RN289185
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 163WI0500X
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Taxonomy Name | Infusion Therapy Registered Nurse
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License Number | RN289185
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 163WS0200X
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Taxonomy Name | School Registered Nurse
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License Number | RN289185
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License Number State | GA
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Taxonomy #5
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Taxonomy Code | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number | RN289185
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License Number State | GA
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