Provider Demographics
NPI:1639847650
Name:COMER, TIFFANY MAE (CRNP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:MAE
Last Name:COMER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:MAE
Other - Last Name:ROMINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:710 W HOBBS ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-1508
Mailing Address - Country:US
Mailing Address - Phone:256-800-2105
Mailing Address - Fax:256-800-2107
Practice Address - Street 1:710 W HOBBS ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-1508
Practice Address - Country:US
Practice Address - Phone:256-800-2105
Practice Address - Fax:256-800-2107
Is Sole Proprietor?:No
Enumeration Date:2021-09-03
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1151911363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL286698Medicaid