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NPI Code Detail

MEDICARE: MRS. TIFFANY REED TATE-WOODARD AGNP

MEDICARE: MRS. TIFFANY REED TATE-WOODARD AGNP
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
1363LG0600XGerontology Nurse Practitioner209.026757IL

General Provider Information

NPI Number : 1639719230
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TIFFANY REED TATE-WOODARD AGNP
Provider Business Mailing Address
First Line : PO BOX 746715
Second Line :
City : ATLANTA
State : GA
Zip : 30374-6715
Country : US
Telephone Number : 618-318-8809
Fax Number : 618-615-4205
Provider Business Practice Location Address
First Line : 2420 STATE ST
Second Line :
City : EAST SAINT LOUIS
State : IL
Zip : 62205-2321
Country : US
Telephone Number : 618-318-8809
Fax Number : 618-615-4205
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2020
Last Update Date : 01/08/2026

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