Provider Demographics
NPI:1215385703
Name:LE, TIFFANY (FNP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:LE
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 1:2476 OCTAVIA LN
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-4981
Mailing Address - Country:US
Mailing Address - Phone:404-414-5745
Mailing Address - Fax:
Practice Address - Street 1:789 CHURCH ST NE STE 200
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7238
Practice Address - Country:US
Practice Address - Phone:770-881-7964
Practice Address - Fax:770-881-7929
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-25
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN210441363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily