Provider Demographics
NPI:1184114282
Name:PENDARVIS, TIFFANY MARIE (LPN)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:MARIE
Last Name:PENDARVIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:MARIE
Other - Last Name:TUMMINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:1091 RANEY HILL RD
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-5259
Mailing Address - Country:US
Mailing Address - Phone:615-202-9485
Mailing Address - Fax:
Practice Address - Street 1:6000 RAMSEY WAY
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2198
Practice Address - Country:US
Practice Address - Phone:615-446-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000074742164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse