Provider Demographics
NPI:1326841255
Name:PRICE, TIFFANY GINGER (DNP, NNP-BC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:GINGER
Last Name:PRICE
Suffix:
Gender:
Credentials:DNP, NNP-BC
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:GINGER
Other - Last Name:SULLENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 190930
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83719-0930
Mailing Address - Country:US
Mailing Address - Phone:208-367-5170
Mailing Address - Fax:208-367-5180
Practice Address - Street 1:1055 N CURTIS RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1309
Practice Address - Country:US
Practice Address - Phone:208-367-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-27
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201903714NP-PP363LN0000X
HIAPRN-4067-0363LN0000X
ID1261172363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal