Provider Demographics
NPI:1003680125
Name:RILEY, TIFFANY TAGGART
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:TAGGART
Last Name:RILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TIFFANY
Other - Middle Name:AMBER
Other - Last Name:TAGGART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3278 BARBARA BIRD ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-2005
Mailing Address - Country:US
Mailing Address - Phone:870-347-6884
Mailing Address - Fax:
Practice Address - Street 1:3278 BARBARA BIRD ST
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-2005
Practice Address - Country:US
Practice Address - Phone:870-347-6884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR107327163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool