Tiffany Hendrickson, APRN
Individual provider Active NPI Family Nurse Practitioner · Park City, IL
NPI 1891284469 · NPPES record last updated Dec 20, 2024
Key facts
- NPI
- 1891284469
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 209027553 (IL)
- Practice address
- 401 Greenleaf St Ste 1
Park City, IL 60085-5744 - Phone
- (847) 662-0978
- NPI assigned
- May 9, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- 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 |
|---|---|---|---|---|
| I20180625002471 | FL | Practitioner - Nurse Practitioner | 9032464516 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209027553 | IL | MD | Family Nurse Practitioner |
Practice roles (1 of 3)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Greenleaf Medical Associates S.C. | Current | Accepting new patients |
Locations
401 Greenleaf St
Ste 1
Park City, IL 60085
Phone (847) 662-0978
Networks
- Freedom Health HMO Network
- Optimum HealthCare HMO Network
Interoperability endpoints
- thendrickson396525@direct.myadvocateaurora.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 209027553 | IL | Yes |
Addresses
Primary practice location
401 Greenleaf St Ste 1
Park City, IL 60085-5744
Mailing address
401 Greenleaf St Ste 1
Park City, IL 60085-5744
Phone (847) 662-0978
Other providers in Park City, IL
- GL Pharmacy LLC
- Greenleaf Medical Associates S.C.
- Greenleaf Memory Clinic PLLC
- Greenleaf Orthodontics - Park City LLC
- Greenleaf Pharmacy Inc
- Kerri Hozeska
- Sydney Renee Jakcsy
- Kokila Avasthi DDS PC
- Sophie Lafayette
- Lake Shore Dermatology, LTD.
All providers in Park City, IL · Family Nurse Practitioner in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 20, 2024. 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.