Provider Demographics
NPI:1497765010
Name:PADILLA, TIFFANY MICHELLE (ANP)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:MICHELLE
Last Name:PADILLA
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23410
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72221-3410
Mailing Address - Country:US
Mailing Address - Phone:501-224-1690
Mailing Address - Fax:501-224-1927
Practice Address - Street 1:1 SAINT VINCENT CIR STE 210
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5407
Practice Address - Country:US
Practice Address - Phone:501-552-6830
Practice Address - Fax:501-552-4178
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01732363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR185074758Medicaid
AR185074758Medicaid
AR5X411Medicare PIN