Individual
MRS. TIFFANY THERESE RICHARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN FNP-BC
Contact information
Practice address
100 SOUTH MAIN STREET, SUITE 2, NORTH LIBERTY, IN 46554
(574) 656-3919
(574) 656-3107
Mailing address
100 SOUTH MAIN STREET P.O. BOX 315, SUITE 2, NORTH LIBERTY, IN 46554
(574) 656-3919
(574) 656-3107
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28147328A
IN
363L00000X
Nurse Practitioner
Primary
71003700A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000816222
BCBS
IN
05
—
201077780
—
IN
Enumeration date
11/02/2011
Last updated
02/13/2023
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