Provider Demographics
NPI:1518691856
Name:BUSSELL, TIFFANY D (FNP-C)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:D
Last Name:BUSSELL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7107 CALGARY DR
Mailing Address - Street 2:
Mailing Address - City:CORRYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37721-3571
Mailing Address - Country:US
Mailing Address - Phone:865-604-9425
Mailing Address - Fax:
Practice Address - Street 1:9625 KROGER PARK DR STE 300
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-5880
Practice Address - Country:US
Practice Address - Phone:865-690-6299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31952363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily