Provider Demographics
NPI:1114271376
Name:TIPTON, TONI (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:TONI
Middle Name:
Last Name:TIPTON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 WILLIAMS DR
Mailing Address - Street 2:STE. 200
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-3285
Mailing Address - Country:US
Mailing Address - Phone:615-890-5484
Mailing Address - Fax:615-890-7924
Practice Address - Street 1:1617 WILLIAMS DR
Practice Address - Street 2:STE. 200
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-3285
Practice Address - Country:US
Practice Address - Phone:615-890-5484
Practice Address - Fax:615-890-7924
Is Sole Proprietor?:No
Enumeration Date:2012-11-08
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17141363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ008872Medicaid
TN103I509804Medicare PIN