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NPI Code Detail

MEDICARE: TIFFANY NICOLE STEWART APRN

MEDICARE: TIFFANY NICOLE STEWART APRN
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
1363LP2300XPrimary Care Nurse PractitionerA005246AR
2363LF0000XFamily Nurse Practitioner0024183941VA

General Provider Information

NPI Number : 1386166411
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANY NICOLE STEWART APRN
Provider Business Mailing Address
First Line : 25 S UNION ST. PETERSBURG, VA 23803
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 23139-5002
Country : US
Telephone Number : 479-586-2335
Fax Number :
Provider Business Practice Location Address
First Line : 25 S UNION ST
Second Line :
City : PETERSBURG
State : VA
Zip : 23803-4221
Country : US
Telephone Number : 479-586-2335
Fax Number : 804-957-5850
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2017
Last Update Date : 01/23/2023

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Directions to “ TIFFANY NICOLE STEWART APRN” Practice Location

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