MEDICARE: TIFFANY J NELSON NP-C

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	363LA2200X	Adult Health Nurse Practitioner	2012022140	MO

General Provider Information

NPI Number	:	1972842359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY J NELSON NP-C

Provider Business Mailing Address
First Line	:	PO BOX 740019
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-0019
Country	:	US
Telephone Number	:	312-733-9730
Fax Number	:

Provider Business Practice Location Address
First Line	:	3451 UNION BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63115-1142
Country	:	US
Telephone Number	:	314-888-0970
Fax Number	:

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

Provider Enumeration Date	:	02/05/2013
Last Update Date	:	01/21/2026

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