Provider Demographics
NPI:1164990396
Name:GALLUCCI, TIFFANY ELIZABETH (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:ELIZABETH
Last Name:GALLUCCI
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 RIVER CLIFF BLVD
Mailing Address - Street 2:
Mailing Address - City:BRANDENBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40108-1444
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4915 NORTON HEALTHCARE BOULEVARD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KS
Practice Address - Zip Code:40241
Practice Address - Country:US
Practice Address - Phone:502-629-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012589363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health