Individual
TIFFANY MARIE HART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
1100 CENTRAL AVE SE, ALBUQUERQUE, NM 87106-4930
(505) 724-6124
(505) 724-6125
Mailing address
PO BOX 26666, PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
64581
NM
Other
Enumeration date
09/15/2021
Last updated
06/28/2023
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