Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC1500X | Nurse Practitioner - Community Health | 5007642 | NC |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | APN.19719 | SC |
NPI | 1255711297 |
---|---|
Provider Name | Mrs. Tiffany Hope Stephens Tyson |
First Address | Myrtle Beach, SC 29572 |
Second Address | Myrtle Beach, SC 29572 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2015 |
Last Update Date | 28/12/2016 |