Provider Demographics
NPI:1386005031
Name:PIERCE, TIFFANY L (NP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:L
Last Name:PIERCE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3711 N EVERBROOK LN
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-5270
Mailing Address - Country:US
Mailing Address - Phone:765-287-8596
Mailing Address - Fax:765-287-8593
Practice Address - Street 1:3711 N EVERBROOK LN
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-5270
Practice Address - Country:US
Practice Address - Phone:765-287-8596
Practice Address - Fax:765-287-8593
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28170140A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner