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General NPI Number Information
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NPI Number | 1700308509
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Entity Type | Individual
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Provider Name | TIFFANY LEE BOULANGER AGACNP
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Gender | Female
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Dates
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Enumeration Date | 07/13/2017
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Last Update Date | 03/28/2025
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Provider Practice Location Address
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Address Line | 400 TOWER RD NE STE 200
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City | MARIETTA
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State | GA
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Zip | 30060-9412
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Country | US
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Telephone | 770-422-1372
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Fax |
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Provider Business Mailing Address
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Address Line | 7400 ABERCORN STREET STE 704 BOX 104
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City | SAVANNAH
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State | GA
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Zip | 31406-2454
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Country | US
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Telephone | 912-232-9700
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Fax | 912-748-0270
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 236517
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License Number State | GA
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