Provider Demographics
NPI:1649686148
Name:WOODARD, TIFFANY (APRN)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:WOODARD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 1960
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-1960
Mailing Address - Country:US
Mailing Address - Phone:870-935-5432
Mailing Address - Fax:870-934-3652
Practice Address - Street 1:1111 WINDOVER RD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6159
Practice Address - Country:US
Practice Address - Phone:870-935-5432
Practice Address - Fax:870-934-3652
Is Sole Proprietor?:No
Enumeration Date:2014-07-03
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004120363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily