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NPI Code Detail

MEDICARE: TIFFANY W OLIVER CRNP

MEDICARE: TIFFANY W OLIVER CRNP
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
1363L00000XNurse Practitioner1136718AL
2363LG0600XGerontology Nurse Practitioner1-136718AL

General Provider Information

NPI Number : 1255725917
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANY W OLIVER CRNP
Provider Business Mailing Address
First Line : 1509 DULLES DR
Second Line :
City : LAFAYETTE
State : LA
Zip : 70506-3718
Country : US
Telephone Number : 337-991-9276
Fax Number : 337-943-0846
Provider Business Practice Location Address
First Line : 2201 N AIRPORT RD
Second Line :
City : JASPER
State : AL
Zip : 35504-7058
Country : US
Telephone Number : 205-221-9351
Fax Number : 205-221-3700
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2015
Last Update Date : 10/27/2022

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