Provider Demographics
NPI:1174172142
Name:HARKLEROAD, TIFFANY LEIGH (NP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LEIGH
Last Name:HARKLEROAD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 E 65TH ST STE 22
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4493
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:912-819-3320
Practice Address - Street 1:1706 ALICE ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-5216
Practice Address - Country:US
Practice Address - Phone:912-490-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN245988363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily