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General NPI Number Information
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NPI Number | 1881282739
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Entity Type | Individual
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Provider Name | TIFFANY RUDESEAL HETHCOX DNP, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 01/06/2021
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Last Update Date | 01/06/2021
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Provider Practice Location Address
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Address Line | 2057 VALLEYDALE RD STE 220
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City | HOOVER
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State | AL
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Zip | 35244-2706
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Country | US
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Telephone | 205-949-1980
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Fax | 205-949-1990
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Provider Business Mailing Address
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Address Line | PO BOX 936
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City | JEMISON
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State | AL
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Zip | 35085-0936
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Country | US
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Telephone | 205-949-1980
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Fax | 205-949-1990
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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 | 1-159325
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License Number State | AL
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