MEDICARE: TIFFANY HEARNSBERGER

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	363L00000X	Nurse Practitioner	A004997	AR

General Provider Information

NPI Number	:	1871039610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY HEARNSBERGER

Provider Business Mailing Address
First Line	:	701 N WEST AVE
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-4654
Country	:	US
Telephone Number	:	870-466-4308
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 N WEST AVE
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-4654
Country	:	US
Telephone Number	:	870-466-4308
Fax Number	:

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

Provider Enumeration Date	:	01/18/2017
Last Update Date	:	01/18/2017

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Directions to “ TIFFANY HEARNSBERGER ” Practice Location

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