Active NPI
Tiffany Anne Bracamonte, NP
- Family Nurse Practitioner
- Springfield, MO
National Provider Identifier
1033633706
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 2017024895
- Practice address
- 1235 E Cherokee St
Springfield, MO 65804-2203 - Phone
- (417) 820-2115
- NPI assigned
- Aug 3, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 2017024895 | MO | Primary |
Addresses
Primary practice location
1235 E Cherokee St
Springfield, MO 65804-2203
Mailing address
1235 E Cherokee St
Springfield, MO 65804-2203
Phone (417) 820-2115
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PENDING | Medicaid | AR | |
| PENDING | Medicaid | MO | |
| PENDING | Medicaid | OK |
Other names 1
- Tiffany Anne Smith
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2017024895 | MO | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lincoln County Hospital | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Critical Access Hospital
- Lincoln, KS
- NPI 1942265327
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1501718400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1033633706",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1235 E CHEROKEE ST",
"city": "SPRINGFIELD",
"state": "MO",
"postal_code": "658042203",
"telephone_number": "417-820-2115"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1235 E CHEROKEE ST",
"city": "SPRINGFIELD",
"state": "MO",
"postal_code": "658042203",
"telephone_number": "417-820-2115"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRACAMONTE",
"first_name": "TIFFANY",
"middle_name": "ANNE",
"credential": "NP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-08-03",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MO",
"license": "2017024895",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PENDING",
"state": "AR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PENDING",
"state": "MO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PENDING",
"state": "OK"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "TIFFANY",
"last_name": "SMITH",
"middle_name": "ANNE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Springfield, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.