Provider Demographics
NPI:1114201068
Name:GRAY, TIFFANY B (FNP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:B
Last Name:GRAY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 E COURT AVE
Mailing Address - Street 2:
Mailing Address - City:SELMER
Mailing Address - State:TN
Mailing Address - Zip Code:38375-2304
Mailing Address - Country:US
Mailing Address - Phone:731-645-7932
Mailing Address - Fax:731-645-5195
Practice Address - Street 1:270 E COURT AVE STE B
Practice Address - Street 2:
Practice Address - City:SELMER
Practice Address - State:TN
Practice Address - Zip Code:38375-2304
Practice Address - Country:US
Practice Address - Phone:731-645-7932
Practice Address - Fax:731-645-5195
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN16100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily