Individual
TIFFANY GRAY MOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
WHNP-BC
Contact information
Practice address
198 NC HIGHWAY 45 N, PLYMOUTH, NC 27962-9232
(252) 791-3119
Mailing address
201 LEIGH ST, EDENTON, NC 27932-1657
(252) 562-4410
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
5009694
NC
Other
Enumeration date
09/12/2017
Last updated
05/11/2020
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