MEDICARE: TIFFANY HOLMAN

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	163W00000X	Registered Nurse	224656	NC

General Provider Information

NPI Number	:	1548676927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY HOLMAN

Provider Business Mailing Address
First Line	:	710 AVONDALE RD
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28054-7218
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	515 CLANTON RD
Second Line	:
City	:	CHARLOTTE
State	:	USA
Zip	:	28054
Country	:	UM
Telephone Number	:	704-332-9001
Fax Number	:

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

Provider Enumeration Date	:	07/07/2014
Last Update Date	:	07/07/2014

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Directions to “ TIFFANY HOLMAN ” Practice Location

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