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General NPI Number Information
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NPI Number | 1972861045
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Entity Type | Individual
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Provider Name | JENNIFER ANN TIFFANY CNM, WHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 04/26/2012
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Last Update Date | 10/23/2025
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Provider Practice Location Address
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Address Line | 2817 ROCK MERRITT AVE
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City | FORT LIBERTY
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State | NC
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Zip | 28310-9137
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Country | US
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Telephone | 910-907-8333
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Fax |
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Provider Business Mailing Address
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Address Line | 336 BRISTLE OAKS DR
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City | RAEFORD
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State | NC
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Zip | 28376-7079
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Country | US
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Telephone | 615-417-1562
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 5005564
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 572
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License Number State | NC
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