Provider Demographics
NPI:1114378817
Name:KING, TIFFANY (APNP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1699 SCHOFIELD AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:SCHOFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54476-2332
Mailing Address - Country:US
Mailing Address - Phone:715-847-6600
Mailing Address - Fax:
Practice Address - Street 1:1699 SCHOFIELD AVE STE 300
Practice Address - Street 2:
Practice Address - City:SCHOFIELD
Practice Address - State:WI
Practice Address - Zip Code:54476-2332
Practice Address - Country:US
Practice Address - Phone:715-847-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI166164-30163W00000X
WI7012-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse