Provider Demographics
NPI:1992488183
Name:FRYER, TIFFANY MINOR (CRNP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:MINOR
Last Name:FRYER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 COLLIER WAY
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-6125
Mailing Address - Country:US
Mailing Address - Phone:205-826-3823
Mailing Address - Fax:
Practice Address - Street 1:1651 RUBY TYLER PKWY
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-2990
Practice Address - Country:US
Practice Address - Phone:205-507-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-103637363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health