Basic Information
| Provider Information | |||||||||
| NPI: | 1972932200 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COGGINS | ||||||||
| FirstName: | TIFFANY | ||||||||
| MiddleName: | |||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1612 N MAIN ST STE B | ||||||||
| Address2: | |||||||||
| City: | SHELBYVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371602392 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9316852022 | ||||||||
| FaxNumber: | 9316854158 | ||||||||
| Practice Location | |||||||||
| Address1: | 1612 N MAIN ST STE B | ||||||||
| Address2: | |||||||||
| City: | SHELBYVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371602392 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9316852022 | ||||||||
| FaxNumber: | 9316854158 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2013 | ||||||||
| LastUpdateDate: | 05/29/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APN0000018060 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.