Provider Demographics
NPI:1255005104
Name:TUFT, ANNETTE MARY (FNP)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:MARY
Last Name:TUFT
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 1:859 S YELLOWSTONE HWY STE 3201
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-6200
Mailing Address - Country:US
Mailing Address - Phone:208-359-2101
Mailing Address - Fax:208-356-8860
Practice Address - Street 1:859 S YELLOWSTONE HWY STE 3201
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-6200
Practice Address - Country:US
Practice Address - Phone:208-359-2101
Practice Address - Fax:208-356-8860
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID58901363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily