Provider Demographics
NPI:1477986081
Name:SKURTU, TIFFANY ROSE (ANP)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:ROSE
Last Name:SKURTU
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Gender:F
Credentials:ANP
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:CB 8058
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-1700
Mailing Address - Fax:314-362-9878
Practice Address - Street 1:1 BARNES JEWISH HOSPITAL PLZ
Practice Address - Street 2:DIV IM HOSPITALIST
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1003
Practice Address - Country:US
Practice Address - Phone:314-362-1700
Practice Address - Fax:314-362-9878
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2021-11-15
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Provider Licenses
StateLicense IDTaxonomies
MO2013008377363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420008668Medicaid
ILENROLLEDMedicaid