Individual ProviderStephanie Ann TippinNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address8028 Carnagie Blvd.,, Suite 200, Fort Wayne, IN 46804(260) 422-7455(260) 373-9728PECOS EnrollmentBased on the most recent information from CMS, provider Stephanie Ann Tippin does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1568483360Provider TypeIndividualFull NameTippin, Stephanie AnnCredentialRN, MSN, FNP-CGenderFemaleSole ProprietorNoEnumeration Date7/21/2006Last Updated12/7/2009Contact InformationPractice LocationPractice Address8028 Carnagie Blvd.,, Suite 200, Fort Wayne, IN 46804Phone(260) 422-7455Fax(260) 755-6233Mailing LocationMailing Address1234 E. Dupont Rd., Suite 3, Fort Wayne, IN 46825-1545Phone(260) 373-9728Fax(260) 373-9740Provider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense28148314AIndianaProvider IdentifiersIDDescriptionIssuerID000000638414DescriptionOtherIssuerANTHEMIndiana