Individual
TIFFANY BURGESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
125 E CHEVES ST, FLORENCE, SC 29506-2526
(843) 317-4073
Mailing address
1566 BUTTER CUP RD, PAMPLICO, SC 29583-6439
(843) 373-8241
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
223021
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3337
MEDICARE
SC
05
—
376241
—
SC
Enumeration date
07/20/2015
Last updated
07/20/2015
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