Basic Information
| Provider Information | |||||||||
| NPI: | 1851767388 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CROFT | ||||||||
| FirstName: | TIFFANY | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN, BSN, WHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1439 S MINTER WAY | ||||||||
| Address2: | |||||||||
| City: | GRAIN VALLEY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640299648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164046785 | ||||||||
| FaxNumber: | 8164046724 | ||||||||
| Practice Location | |||||||||
| Address1: | 1439 S MINTER WAY | ||||||||
| Address2: | |||||||||
| City: | GRAIN VALLEY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640299648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164046785 | ||||||||
| FaxNumber: | 8164046724 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2015 | ||||||||
| LastUpdateDate: | 12/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | 2010018977 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
ID Information
| ID | Type | State | Issuer | Description | 420048038 | 05 | MO | MEDICAID |