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General NPI Number Information
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NPI Number | 1760070809
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Entity Type | Individual
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Provider Name | TIFFANEE RACHELLE MOORE CRNP
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Gender | Female
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Dates
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Enumeration Date | 01/05/2021
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Last Update Date | 02/01/2021
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Provider Practice Location Address
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Address Line | 1121 GREENWOOD XING STE 101
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City | BESSEMER
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State | AL
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Zip | 35022-5687
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Country | US
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Telephone | 866-284-8788
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Fax |
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Provider Business Mailing Address
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Address Line | 416 GREY OAKS DR
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City | PELHAM
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State | AL
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Zip | 35124-2541
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Country | US
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Telephone | 334-549-3575
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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 | 1-142871
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License Number State | AL
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