Doctor Name: | MRS. TIFFANY G. REVELS |
NPI Number: | 1306936166 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 0050-02177 |
Business Practice Address: | 13440 Nc Highway 210 Benson, NC - 275047725 |
Business Phone Number: | 9192073086 |
Business Fax Number: | |
Mailing Address: | 13440 Nc Highway 210, BENSON |
State: | NC |
Postal Code: | 275047725 |
Phone Number: | 9192073086 |
Fax Number: | |
NPI Enumeration Date: | 10/13/2006 |
NPI Last Update Date: | 08/26/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 0050-02177 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |