MEDICARE: MS. TIFFANY BRUSH NP-C

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	APRN-NP220871	GA

General Provider Information

NPI Number	:	1407333115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TIFFANY BRUSH NP-C

Provider Business Mailing Address
First Line	:	961 SMOKEY MOUNTAIN SPRINGS LN NE
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30501-2418
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	961 SMOKEY MOUNTAIN SPRINGS LN NE
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30501-2418
Country	:	US
Telephone Number	:	678-210-2172
Fax Number	:

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

Provider Enumeration Date	:	07/25/2018
Last Update Date	:	10/10/2025

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