| NPI | 1972245256 |
|---|---|
| Former Name | TIFFANY DIANNE FOGLE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: SC 25803) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: SC 25803) |
| Enumeration Date | 2022-04-08 |
| Last Update Date | 2022-04-08 |