Provider Demographics
NPI:1497261093
Name:HOLCOMB, TIFFANY PAIGE (APRN, FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:PAIGE
Last Name:HOLCOMB
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:MS
Other - First Name:TIFFANY
Other - Middle Name:PAIGE
Other - Last Name:HOLCOMB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN, FNP-BC
Mailing Address - Street 1:9146 HIGHWAY 63 N
Mailing Address - Street 2:
Mailing Address - City:BONO
Mailing Address - State:AR
Mailing Address - Zip Code:72416-8153
Mailing Address - Country:US
Mailing Address - Phone:870-930-9990
Mailing Address - Fax:
Practice Address - Street 1:9146 HIGHWAY 63 N
Practice Address - Street 2:
Practice Address - City:BONO
Practice Address - State:AR
Practice Address - Zip Code:72416-8153
Practice Address - Country:US
Practice Address - Phone:870-930-9990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-18
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005418363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily