Provider Demographics
NPI:1952832701
Name:TEMPLETON, TIFFANY (ACNPC-AG)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:TEMPLETON
Suffix:
Gender:F
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1932 CLEES TRL
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-0149
Mailing Address - Country:US
Mailing Address - Phone:276-224-2194
Mailing Address - Fax:
Practice Address - Street 1:434 N TRADE ST STE 104
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-1865
Practice Address - Country:US
Practice Address - Phone:704-246-3936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5013497363LG0600X
SC20878363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1952832701OtherNPI