Provider Demographics
NPI:1871242263
Name:GEARHART, TIFFANY M (NP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:M
Last Name:GEARHART
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:M
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:7613 W JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-4181
Mailing Address - Country:US
Mailing Address - Phone:260-469-7337
Mailing Address - Fax:260-469-7340
Practice Address - Street 1:7613 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4181
Practice Address - Country:US
Practice Address - Phone:260-469-7337
Practice Address - Fax:260-469-7340
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28248540A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily