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Individual
TIFT PALMER WALLACE
Active
Individual
TIFT PALMER WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
32700
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100969050
—
KY
05
—
Q078538
—
TN
Enumeration date
10/17/2022
Last updated
09/10/2025
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