Individual
TIFFANY LACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, FNP-BC
Contact information
Practice address
2001 CLUB MANOR DR STE S, MAUMELLE, AR 72113-7417
(501) 734-8085
(501) 734-8085
Mailing address
2001 CLUB MANOR DR STE S, MAUMELLE, AR 72113-7417
(501) 734-8085
(501) 734-8088
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
123569
AR
Other
Enumeration date
08/06/2019
Last updated
04/24/2024
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