Provider Demographics
NPI:1740168376
Name:KRUSE, TIFFINY TERESA (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:TIFFINY
Middle Name:TERESA
Last Name:KRUSE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7041 COUNTRY VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-9218
Mailing Address - Country:US
Mailing Address - Phone:248-302-9261
Mailing Address - Fax:
Practice Address - Street 1:7041 COUNTRY VIEW BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-9218
Practice Address - Country:US
Practice Address - Phone:313-595-8578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704266320363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily