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Individual
TIFFANY A THACKER
Active
Individual
TIFFANY A THACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28178065A
IN
363LF0000X
Family Nurse Practitioner
Primary
71006785A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300007877
—
IN
Enumeration date
12/30/2016
Last updated
02/16/2024
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