Provider Demographics
NPI:1740566827
Name:RICHARDS, TIFFANY THERESE (APRN FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:THERESE
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:APRN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 SOUTH MAIN STREET P.O. BOX 315
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IN
Mailing Address - Zip Code:46554
Mailing Address - Country:US
Mailing Address - Phone:574-656-3919
Mailing Address - Fax:574-656-3107
Practice Address - Street 1:100 SOUTH MAIN STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:NORTH LIBERTY
Practice Address - State:IN
Practice Address - Zip Code:46554
Practice Address - Country:US
Practice Address - Phone:574-656-3919
Practice Address - Fax:574-656-3107
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28147328A163W00000X
IN71003700A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000816222OtherBCBS
IN201077780Medicaid
IN187730010Medicare PIN
INP01265124Medicare PIN