Provider Demographics
NPI:1225532450
Name:STIFF, TABITHA NICOLE (FNP)
Entity Type:Individual
Prefix:MS
First Name:TABITHA
Middle Name:NICOLE
Last Name:STIFF
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 1:207 E SIXTH ST
Mailing Address - Street 2:
Mailing Address - City:YAZOO CITY
Mailing Address - State:MS
Mailing Address - Zip Code:39194-3621
Mailing Address - Country:US
Mailing Address - Phone:601-473-5780
Mailing Address - Fax:
Practice Address - Street 1:123 N FRONT ST
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MS
Practice Address - Zip Code:38967-2239
Practice Address - Country:US
Practice Address - Phone:662-283-2505
Practice Address - Fax:601-825-8130
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902458363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily