Provider Demographics
NPI:1518415298
Name:RHOADES, TIFFANY (FNP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:RHOADES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:EAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5445 AVENUE O
Mailing Address - Street 2:
Mailing Address - City:FORT MADISON
Mailing Address - State:IA
Mailing Address - Zip Code:52627-9611
Mailing Address - Country:US
Mailing Address - Phone:319-372-6530
Mailing Address - Fax:
Practice Address - Street 1:5445 AVENUE O
Practice Address - Street 2:
Practice Address - City:FORT MADISON
Practice Address - State:IA
Practice Address - Zip Code:52627-9611
Practice Address - Country:US
Practice Address - Phone:319-372-6530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA121682363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner