Provider Demographics
NPI:1063782126
Name:MELBERG, TIFFANY ANN (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANN
Last Name:MELBERG
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 E CENTURY AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0639
Mailing Address - Country:US
Mailing Address - Phone:701-339-0300
Mailing Address - Fax:701-401-0299
Practice Address - Street 1:1830 E CENTURY AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0639
Practice Address - Country:US
Practice Address - Phone:701-751-0699
Practice Address - Fax:701-401-0299
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR30057363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health