Provider Demographics
NPI:1932726007
Name:MYERS, TIFFANY WEEKS (APRN, FNP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:WEEKS
Last Name:MYERS
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:SHANIKA
Other - Last Name:WEEKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1330 DUTCH FORK ROAD
Mailing Address - Street 2:
Mailing Address - City:BALLENTINE
Mailing Address - State:SC
Mailing Address - Zip Code:29002
Mailing Address - Country:US
Mailing Address - Phone:803-749-1666
Mailing Address - Fax:
Practice Address - Street 1:1330 DUTCH FORK RD
Practice Address - Street 2:
Practice Address - City:BALLENTINE
Practice Address - State:SC
Practice Address - Zip Code:29002-0568
Practice Address - Country:US
Practice Address - Phone:803-749-1666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23765363LF0000X
SCF12190057363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC23765OtherAPRN