Tiffany Brooke Boardwine
Individual provider Active NPI Driver · Bristol, VA
NPI 1972979565 · NPPES record last updated Aug 18, 2015
Key facts
- NPI
- 1972979565
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- License
- T66522665 (VA)
- Practice address
- 13039 King Mill Pike
Bristol, VA 24202-4405 - Phone
- (276) 202-4032
- NPI assigned
- Aug 18, 2015
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| T66522665 | VA | MD | Driver |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | T66522665 | VA | Yes |
Addresses
Primary practice location
13039 King Mill Pike
Bristol, VA 24202-4405
Mailing address
13039 King Mill Pike
Bristol, VA 24202-4405
Phone (276) 202-4032
Other providers in Bristol, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 18, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.