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NPI Code Detail

MEDICARE: TIFFANY FEARON

MEDICARE: TIFFANY FEARON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner26NJ00481400NJ

General Provider Information

NPI Number : 1164846325
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANY FEARON
Provider Business Mailing Address
First Line : 3110 ROUTE 38
Second Line :
City : MOUNT LAUREL
State : NJ
Zip : 08054-9724
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3110 ROUTE 38
Second Line :
City : MOUNT LAUREL
State : NJ
Zip : 08054-9724
Country : US
Telephone Number : 866-389-2727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2014
Last Update Date : 08/13/2016

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Directions to “ TIFFANY FEARON ” Practice Location

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