Provider Demographics
NPI:1376178343
Name:WARD, TIFFANY (FNP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:WARD
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 1:315 N WASHINTON AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2421
Mailing Address - Country:US
Mailing Address - Phone:931-651-1918
Mailing Address - Fax:931-651-1912
Practice Address - Street 1:315 N WASHINGTON AVE STE 102
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2623
Practice Address - Country:US
Practice Address - Phone:931-651-1918
Practice Address - Fax:931-651-1916
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-10
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27302363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner