Provider Demographics
NPI:1659099257
Name:MERCHANT, TIFFANY AMBER (CRNP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:AMBER
Last Name:MERCHANT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21875 STATE HIGHWAY 181
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-4481
Mailing Address - Country:US
Mailing Address - Phone:251-928-1442
Mailing Address - Fax:251-210-0969
Practice Address - Street 1:21875 STATE HIGHWAY 181
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-4481
Practice Address - Country:US
Practice Address - Phone:251-928-1442
Practice Address - Fax:251-210-0969
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-123575363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily