Provider Demographics
NPI:1851857445
Name:HARDY, TIFFANY ANGELA (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:ANGELA
Last Name:HARDY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2781 COUNTY ROAD 51
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35652-3124
Mailing Address - Country:US
Mailing Address - Phone:228-697-9072
Mailing Address - Fax:
Practice Address - Street 1:1701 VETERANS DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-4928
Practice Address - Country:US
Practice Address - Phone:256-629-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-126513363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily