Individual provider · Type 1 NPI
Tiffany Reed Tate-Woodard, AGNP
Gerontology Nurse Practitioner · East St. Louis, IL
NPI number
1639719230
Active
Practice location
2420 State St
East St. Louis, IL 62205-2321
Fax (618) 615-4205
Mailing address
PO Box 746715
Atlanta, GA 30374-6715
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Gerontology Nurse Practitioner Primary | 363LG0600X | 209.026757 (IL) |
Gerontology Nurse Practitioner: Definition to come...
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About NPI 1639719230
Tiffany Reed Tate-Woodard, AGNP's National Provider Identifier is 1639719230, issued on Jan 10, 2020. The primary taxonomy on file is Gerontology Nurse Practitioner (363LG0600X), and the practice location is in East St. Louis, IL. The record was last updated on Jan 8, 2026.