Individual
TIFFANY JOHNSON BEATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
125 E IDAHO ST STE 100, BOISE, ID 83712-6202
(208) 338-0148
Mailing address
125 E IDAHO ST STE 100, BOISE, ID 83712-6202
(208) 338-0148
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
70832
ID
Other
Enumeration date
01/11/2022
Last updated
03/16/2023
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