Provider Demographics
NPI:1851767388
Name:CROFT, TIFFANY (RN, BSN, WHNP-BC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:CROFT
Suffix:
Gender:F
Credentials:RN, BSN, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1439 S MINTER WAY
Mailing Address - Street 2:
Mailing Address - City:GRAIN VALLEY
Mailing Address - State:MO
Mailing Address - Zip Code:64029-9648
Mailing Address - Country:US
Mailing Address - Phone:816-404-6785
Mailing Address - Fax:816-404-6724
Practice Address - Street 1:1439 S MINTER WAY
Practice Address - Street 2:
Practice Address - City:GRAIN VALLEY
Practice Address - State:MO
Practice Address - Zip Code:64029-9648
Practice Address - Country:US
Practice Address - Phone:816-404-6785
Practice Address - Fax:816-404-6724
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010018977363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420048038Medicaid