Provider Demographics
NPI:1093470296
Name:BALLINGTON, TIFFANY (NP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:BALLINGTON
Suffix:
Gender:F
Credentials:NP
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 6130
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304-6130
Mailing Address - Country:US
Mailing Address - Phone:864-583-0053
Mailing Address - Fax:864-583-0147
Practice Address - Street 1:7021 SAINT ANDREWS RD STE 1
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-1177
Practice Address - Country:US
Practice Address - Phone:864-260-6995
Practice Address - Fax:864-884-9909
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25540363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP8468Medicaid