MEDICARE: MRS. TIFFANY THERESE RICHARDS APRN FNP-BC

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	28147328A	IN
2	363L00000X	Nurse Practitioner	71003700A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000816222	OTHER	IN	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740566827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TIFFANY THERESE RICHARDS APRN FNP-BC

Provider Business Mailing Address
First Line	:	100 SOUTH MAIN STREET P.O. BOX 315
Second Line	:	SUITE 2
City	:	NORTH LIBERTY
State	:	IN
Zip	:	46554
Country	:	US
Telephone Number	:	574-656-3919
Fax Number	:	574-656-3107

Provider Business Practice Location Address
First Line	:	100 SOUTH MAIN STREET
Second Line	:	SUITE 2
City	:	NORTH LIBERTY
State	:	IN
Zip	:	46554
Country	:	US
Telephone Number	:	574-656-3919
Fax Number	:	574-656-3107

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

Provider Enumeration Date	:	11/02/2011
Last Update Date	:	02/13/2023

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