Provider Demographics
NPI:1972254191
Name:NICHOLS, TIFFANY (MSN ED RN CPC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MSN ED RN CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 FORT DOBBS RD
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-1908
Mailing Address - Country:US
Mailing Address - Phone:704-880-5581
Mailing Address - Fax:
Practice Address - Street 1:161 FORT DOBBS RD
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-1908
Practice Address - Country:US
Practice Address - Phone:704-880-5581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC150804163WC1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development