Provider Demographics
NPI:1598155004
Name:KREUN, TIFFANY (ACNP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:KREUN
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 FAIR RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-1698
Mailing Address - Country:US
Mailing Address - Phone:912-681-4911
Mailing Address - Fax:912-681-6911
Practice Address - Street 1:1601 FAIR RD
Practice Address - Street 2:SUITE 600
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-1698
Practice Address - Country:US
Practice Address - Phone:912-681-4911
Practice Address - Fax:912-681-6911
Is Sole Proprietor?:No
Enumeration Date:2015-02-04
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN205413363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care