MEDICARE: TIFFANY NICOLE VANOVER FNP

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
1	363LF0000X	Family Nurse Practitioner	296951	GA

General Provider Information

NPI Number	:	1346172509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY NICOLE VANOVER FNP

Provider Business Mailing Address
First Line	:	2994 EASY ST
Second Line	:
City	:	WESTON
State	:	GA
Zip	:	31832-2504
Country	:	US
Telephone Number	:	229-321-9355
Fax Number	:

Provider Business Practice Location Address
First Line	:	2410 SYLVESTER HWY
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31705-2479
Country	:	US
Telephone Number	:	229-312-9220
Fax Number	:	229-312-9205

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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