Provider Demographics
NPI:1568171585
Name:LIST, TIFFANY TERRI (NP)
Entity type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:TERRI
Last Name:LIST
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 1:5566 S 56TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-1834
Mailing Address - Country:US
Mailing Address - Phone:402-423-3839
Mailing Address - Fax:
Practice Address - Street 1:5566 S 56TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-1834
Practice Address - Country:US
Practice Address - Phone:402-423-3839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-17
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE114496363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily