Provider Demographics
NPI:1588478515
Name:MATTHEWS, TIFFANY LANISE (PMHNP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LANISE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5865 RIDGEWAY CENTER PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-4014
Mailing Address - Country:US
Mailing Address - Phone:901-410-2090
Mailing Address - Fax:901-410-2090
Practice Address - Street 1:5865 RIDGEWAY CENTER PKWY STE 300
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-4014
Practice Address - Country:US
Practice Address - Phone:901-410-2090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-01
Last Update Date:2025-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38018363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health