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General NPI Number Information
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NPI Number | 1750860755
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Entity Type | Individual
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Provider Name | TIFFANY CIARA SMITH MSN, APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 08/09/2018
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Last Update Date | 05/23/2019
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Provider Practice Location Address
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Address Line | 1400 J R LYNCH ST
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City | JACKSON
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State | MS
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Zip | 39217-5511
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Country | US
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Telephone | 601-979-2260
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Fax | 601-979-9228
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Provider Business Mailing Address
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Address Line | 222 GRACE DR
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City | FLOWOOD
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State | MS
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Zip | 39232-5511
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Country | US
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Telephone | 601-807-6175
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 902856
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License Number State | MS
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