Provider Demographics
NPI:1699940973
Name:LUDICK, TIFFANY (MSN, FNP)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:
Last Name:LUDICK
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:648 HARTSVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-2523
Mailing Address - Country:US
Mailing Address - Phone:615-451-9246
Mailing Address - Fax:615-452-9410
Practice Address - Street 1:306 W LOCUST ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:TN
Practice Address - Zip Code:37083-1713
Practice Address - Country:US
Practice Address - Phone:615-688-7012
Practice Address - Fax:615-688-7014
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN120825363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily