MEDICARE: TIFFANY CLEVELAND

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-NP306258	GA

General Provider Information

NPI Number	:	1568317089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY CLEVELAND

Provider Business Mailing Address
First Line	:	90 HUNTERS RIDGE DR
Second Line	:
City	:	COVINGTON
State	:	GA
Zip	:	30014-8433
Country	:	US
Telephone Number	:	706-476-3878
Fax Number	:

Provider Business Practice Location Address
First Line	:	90 HUNTERS RIDGE DR
Second Line	:
City	:	COVINGTON
State	:	GA
Zip	:	30014-8433
Country	:	US
Telephone Number	:	706-476-3878
Fax Number	:

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

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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Directions to “ TIFFANY CLEVELAND ” Practice Location

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