Individual
TIFFANY LACOLE HAYES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSN, ARNP, FNP-BC
Contact information
Practice address
2051 CLEVIDENCE BLVD, SUITE 1, CLARKSVILLE, IN 47129-2278
(812) 280-9145
(812) 280-6627
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28165938A
IN
163WE0003X
Emergency Registered Nurse
1116764
KY
363L00000X
Nurse Practitioner
Primary
3007179
KY
363LF0000X
Family Nurse Practitioner
3007179
KY
363LF0000X
Family Nurse Practitioner
71003799A
IN
363LF0000X
Family Nurse Practitioner
71003799B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000746934
ANTHEM - NICC
KY
01
—
132355
SIHO
KY
05
—
201054410
—
IN
Enumeration date
11/21/2011
Last updated
07/11/2016
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