MEDICARE: TIFFANY GARRETT CRNP

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	363LP0200X	Pediatric Nurse Practitioner	1-126808	AL

General Provider Information

NPI Number	:	1831722289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY GARRETT CRNP

Provider Business Mailing Address
First Line	:	169 JOE PHILLIPS RD
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35758-9769
Country	:	US
Telephone Number	:	330-618-5335
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 WHITESPORT DR SW STE 104
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-3455
Country	:	US
Telephone Number	:	256-880-0376
Fax Number	:

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

Provider Enumeration Date	:	02/13/2020
Last Update Date	:	02/13/2020

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