Provider Demographics
NPI:1598301905
Name:CARMICHAEL, TIFFANY JANE (FNP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:JANE
Last Name:CARMICHAEL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 E BROADWAY STE 240
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8022
Mailing Address - Country:US
Mailing Address - Phone:573-815-8145
Mailing Address - Fax:
Practice Address - Street 1:1601 E BROADWAY STE 240
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8022
Practice Address - Country:US
Practice Address - Phone:573-815-8145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-20
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020000699363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily