Provider Demographics
NPI:1568483360
Name:TIPPIN, STEPHANIE ANN (RN, MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:TIPPIN
Suffix:
Gender:F
Credentials:RN, MSN, FNP-C
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:ANN
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, MSN, FNP-C
Mailing Address - Street 1:1234 E. DUPONT RD.
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1545
Mailing Address - Country:US
Mailing Address - Phone:260-373-9728
Mailing Address - Fax:260-373-9740
Practice Address - Street 1:8028 CARNAGIE BLVD.,
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804
Practice Address - Country:US
Practice Address - Phone:260-422-7455
Practice Address - Fax:260-755-6233
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28148314A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000638414OtherANTHEM