Provider Demographics
NPI:1649933177
Name:MUELLER, TIFFANY RAYE (CNP, PMHNP)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:RAYE
Last Name:MUELLER
Suffix:
Gender:F
Credentials:CNP, PMHNP
Other - Prefix:MS
Other - First Name:TIFFANY
Other - Middle Name:RAYE
Other - Last Name:ACKERMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNP
Mailing Address - Street 1:1610 8TH AVE E.
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308
Mailing Address - Country:US
Mailing Address - Phone:320-335-6217
Mailing Address - Fax:320-759-1014
Practice Address - Street 1:1610 8TH AVE E.
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308
Practice Address - Country:US
Practice Address - Phone:320-335-6217
Practice Address - Fax:320-759-1014
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-21
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2186375163W00000X
MN8684363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse