Provider Demographics
NPI:1922475532
Name:ANDERSON ONGERS, TIFFANY
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:ANDERSON ONGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2490 PARR AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-2029
Mailing Address - Country:US
Mailing Address - Phone:731-286-8007
Mailing Address - Fax:731-286-8019
Practice Address - Street 1:1705 SE MEADOWBROOK BLVD STE 2
Practice Address - Street 2:
Practice Address - City:COLLEGE PLACE
Practice Address - State:WA
Practice Address - Zip Code:99324-1756
Practice Address - Country:US
Practice Address - Phone:425-276-3455
Practice Address - Fax:509-529-2858
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20397363LF0000X
WAAP60724010363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily