Provider Demographics
NPI:1457967226
Name:PRISOCK, TIFFINE LYNN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:TIFFINE
Middle Name:LYNN
Last Name:PRISOCK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24978 MS-15
Mailing Address - Street 2:
Mailing Address - City:MATHISTON
Mailing Address - State:MS
Mailing Address - Zip Code:39752
Mailing Address - Country:US
Mailing Address - Phone:662-634-3089
Mailing Address - Fax:
Practice Address - Street 1:24978 MS-15
Practice Address - Street 2:
Practice Address - City:MATHISTON
Practice Address - State:MS
Practice Address - Zip Code:39752
Practice Address - Country:US
Practice Address - Phone:662-634-3089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904155207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine