Provider Demographics
NPI:1124625504
Name:SWANSON, TIFFANY ANNE (FNP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANNE
Last Name:SWANSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:TIFFANY
Other - Middle Name:ANNE
Other - Last Name:SWANSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:910 SYCAMORE RD
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253-3147
Mailing Address - Country:US
Mailing Address - Phone:336-269-2008
Mailing Address - Fax:
Practice Address - Street 1:1987 HILTON RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-2968
Practice Address - Country:US
Practice Address - Phone:336-226-6247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-08
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC258468207Q00000X
NC5013731363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty