Provider Demographics
NPI:1033749262
Name:WARD, TIFFANY A (ARNP-C)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:A
Last Name:WARD
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 MCGHEE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:KOOTENAI
Mailing Address - State:ID
Mailing Address - Zip Code:83840-0040
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:130 MCGHEE RD STE 101
Practice Address - Street 2:
Practice Address - City:KOOTENAI
Practice Address - State:ID
Practice Address - Zip Code:83840-0040
Practice Address - Country:US
Practice Address - Phone:208-263-0450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX832267163W00000X
ID73614363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse