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General NPI Number Information
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NPI Number | 1770018095
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Entity Type | Individual
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Provider Name | TIFFANY BRUNSON FNP-C
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Gender | Female
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Dates
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Enumeration Date | 04/24/2017
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Last Update Date | 09/08/2020
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Provider Practice Location Address
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Address Line | 9915 PARK CEDAR DR
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City | CHARLOTTE
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State | NC
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Zip | 28210-8905
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Country | US
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Telephone | 704-544-3263
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Fax |
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Provider Business Mailing Address
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Address Line | 1720 RIPPLE WAY UNIT 2301
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City | CHARLOTTE
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State | NC
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Zip | 28262-6601
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Country | US
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Telephone | 843-992-9415
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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 | 20898
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5011708
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License Number State | NC
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