Provider Demographics
NPI:1942075296
Name:WISEMAN, TIFFANY PAIGE (PMHNP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:PAIGE
Last Name:WISEMAN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 SAFE HAVEN CIR
Mailing Address - Street 2:
Mailing Address - City:ESTILL SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37330-5408
Mailing Address - Country:US
Mailing Address - Phone:931-308-5420
Mailing Address - Fax:
Practice Address - Street 1:1453 HOPE WAY
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-3140
Practice Address - Country:US
Practice Address - Phone:615-893-9390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35242363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health