Individual
JEFFREY P TIPTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
15200 COMMUNITY RD, GULFPORT, MS 39503-3085
(228) 575-7112
(228) 575-7190
Mailing address
2101 HIGHWAY 90, GAUTIER, MS 39553-5340
(228) 497-7576
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
R857207
MS
363LA2100X
Acute Care Nurse Practitioner
Primary
R857207
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04684771
—
MS
Enumeration date
10/14/2010
Last updated
05/20/2022
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