Provider Demographics
NPI:1659819944
Name:GLASS, TIFFANY M (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:M
Last Name:GLASS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 PEMBERTON CV
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-5514
Mailing Address - Country:US
Mailing Address - Phone:731-394-1145
Mailing Address - Fax:
Practice Address - Street 1:950 HIGHPOINT DR
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-2570
Practice Address - Country:US
Practice Address - Phone:731-394-1145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS119398163W00000X
TN209259163W00000X
CA95283752163W00000X
PARN770932163W00000X
CT213897163W00000X
IL041529567163W00000X
TN22309363LF0000X
CA95027760363LF0000X
AZ271648363LF0000X
IAA168482363LF0000X
MECNP231450363LF0000X
WV117579363LF0000X
NH092659-23363LF0000X
KY3011195363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse