Individual
TIFFANY BROSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
4215 15TH ST, GULFPORT, MS 39501-2523
(228) 863-5211
(228) 863-4101
Mailing address
4215 15TH STREET, GULFPORT, MS 39501
(228) 863-5211
(228) 863-4101
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
901909
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05859035
—
MS
Enumeration date
01/20/2017
Last updated
03/17/2018
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