Tiffany Bowen, NP
Individual provider Active NPI Family Nurse Practitioner · La Porte, IN
NPI 1750823795 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1750823795
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 71006816A (IN)
- Practice address
- 508 Legacy PLZ W
La Porte, IN 46350-5254 - Phone
- (219) 575-6244
- Fax
- (219) 380-0757
- NPI assigned
- Nov 8, 2016
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170216000706 | IN | Practitioner - Nurse Practitioner | 1355624362 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28199198A | IN | MD | Family Nurse Practitioner |
| 71006816A | IN | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chestnut Health of Indiana PC | Current |
Accepting new patients | |
| Porter Physician Services LLC | Current |
Accepting new patients | |
| Porter Physician Services LLC | Past | Accepting new patients |
Locations
1530 N Randall Rd
Ste 210
Elgin, IL 60123
Phone (224) 760-7322
650 Dickinson Rd
Chesterton, IN 46304
Phone 21926346008228
650 Dickinson Rd
Ste Z
Chesterton, IN 46304
Phone (219) 464-9507
104 E Culver Rd
Ste 105
Knox, IN 46534
Phone (574) 772-7300
3518 S Lafountain St
Kokomo, IN 46902
Phone (765) 453-0358
508 Legacy Plz W
Laporte, IN 46350
Phone (219) 575-6244
3630 Willowcreek Rd
Portage, IN 46368
Phone (219) 364-3000
809 Laporte Ave
#B
Valparaiso, IN 46383
Phone (219) 263-4977
Interoperability endpoints
- tiffany.bowen@laportehosp.cernerdirect.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 28199198A | IN | |
| Family Nurse Practitioner | 363LF0000X | 71006816A | IN | Yes |
Addresses
Primary practice location
508 Legacy PLZ W
La Porte, IN 46350-5254
Mailing address
211 N Eddy St
South Bend, IN 46617-2808
Phone (574) 239-1433
Other practice location 1
211 N Eddy St
South Bend, IN 46617-2808
Phone (574) 239-1433
Other practice location 2
809 LaPorte Ave Ste B
Valparaiso, IN 46383-5801
Phone (219) 263-4977
Other practice location 3
650 Dickinson Rd
Chesterton, IN 46304-3387
Phone (219) 926-7755
Other practice location 4
3630 Willowcreek Rd
Portage, IN 46368-5075
Phone (219) 364-3900
Other names
- Tiffany Efantis
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | Tiffany.Bowen@laportehosp.cernerdirect.com |
Other providers in La Porte, IN
- Pamela Ann Boardman
- Janice Marie Bohlim
- Dawn L. Bohnert
- Michelle Boren
- Marissa Bottos
- Stacy Lynn Brand-Lesley
- Carley Joy Brewster
- Brittany Brice
- Sarah Georgetta Jean Brinckman
- Alyssa Budzik
All providers in La Porte, IN · Family Nurse Practitioner in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.