Provider Demographics
NPI:1003402629
Name:MULLINS, TIFFANY BETH (RN)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:BETH
Last Name:MULLINS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1480
Mailing Address - Street 2:
Mailing Address - City:POUND
Mailing Address - State:VA
Mailing Address - Zip Code:24279-1480
Mailing Address - Country:US
Mailing Address - Phone:276-796-2200
Mailing Address - Fax:276-796-2202
Practice Address - Street 1:11231 INDIAN CREEK RD
Practice Address - Street 2:
Practice Address - City:POUND
Practice Address - State:VA
Practice Address - Zip Code:24279
Practice Address - Country:US
Practice Address - Phone:276-796-2200
Practice Address - Fax:276-796-2202
Is Sole Proprietor?:No
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0230012735183700000X
VA0001228247163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No183700000XPharmacy Service ProvidersPharmacy Technician