Provider Demographics
NPI:1831532704
Name:CARSWELL, TIFFANY GAULDEN (NP)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:GAULDEN
Last Name:CARSWELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4363
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208-4363
Mailing Address - Country:US
Mailing Address - Phone:478-787-4266
Mailing Address - Fax:478-787-4199
Practice Address - Street 1:770 WALNUT ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-7307
Practice Address - Country:US
Practice Address - Phone:478-787-4266
Practice Address - Fax:478-787-4199
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA145535363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily