Individual
TIFFANY MARIE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
508 FULTON ST, DURHAM, NC 27705-3875
(919) 286-0411
Mailing address
508 FULTON ST, DURHAM, NC 27705-3875
(919) 286-0411
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
5005600
NC
Other
Enumeration date
05/15/2012
Last updated
09/24/2019
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