Provider Demographics
NPI:1770854481
Name:MENSI, TIFFANY (FNP-C)
Entity Type:Individual
Prefix:MISS
First Name:TIFFANY
Middle Name:
Last Name:MENSI
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:HOLLIDAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 22389
Mailing Address - Street 2:PMB 82739
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37202
Mailing Address - Country:US
Mailing Address - Phone:866-315-2626
Mailing Address - Fax:
Practice Address - Street 1:105 HARDY COURT SHOPPING CTR STE 117
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-2528
Practice Address - Country:US
Practice Address - Phone:228-678-2459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-26
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06738363LF0000X
MSR881126363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00600252Medicaid
MSP01419713OtherRAILROAD MEDICARE PTAN
MS379861YXTJMedicare Oscar/Certification