Provider Demographics
NPI:1255711297
Name:SHEPHERD, TIFFANY HOPE
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:HOPE
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:HOPE STEPHENS
Other - Last Name:TYSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:6507 NORTH KINGS HWY
Mailing Address - Street 2:DR NORMAN'S MYRTLE BEACH DIET & REGENERATIVE CENTER
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572
Mailing Address - Country:US
Mailing Address - Phone:843-692-9494
Mailing Address - Fax:843-692-7474
Practice Address - Street 1:6507 NORTH KINGS HWY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572
Practice Address - Country:US
Practice Address - Phone:843-692-9494
Practice Address - Fax:843-692-7474
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007642363LC1500X, 363L00000X
SCAPN.19719363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily