Provider Demographics
NPI:1538564448
Name:PERDUE, TIFFANY N (FNP-BC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:N
Last Name:PERDUE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26242 S PEACH TREE LN
Mailing Address - Street 2:
Mailing Address - City:MONEE
Mailing Address - State:IL
Mailing Address - Zip Code:60449-8009
Mailing Address - Country:US
Mailing Address - Phone:708-653-6803
Mailing Address - Fax:
Practice Address - Street 1:4749 LINCOLN MALL DR STE 540
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2348
Practice Address - Country:US
Practice Address - Phone:815-412-4245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2024-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041386465163W00000X
IL277.002126363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse