Provider Demographics
NPI:1225687734
Name:PINGER, TIFFANY K (RN, MSN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:K
Last Name:PINGER
Suffix:
Gender:F
Credentials:RN, MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:IL
Mailing Address - Zip Code:61231-8576
Mailing Address - Country:US
Mailing Address - Phone:309-224-6877
Mailing Address - Fax:
Practice Address - Street 1:3375 N SEMINARY ST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-1251
Practice Address - Country:US
Practice Address - Phone:309-343-5114
Practice Address - Fax:309-343-7859
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-06
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA156351363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily