Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Tiffany Lee Boulanger, AGACNP

Individual provider Acute Care Nurse Practitioner · NPI 1700308509

Tiffany Lee Boulanger, AGACNP is a Nurse Practitioner in Marietta, Georgia. Qualified in 2017, 9 years ago. Practices with Wellstar Medical Group LLC, a 3,072-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Georgia.

Years since qualifying
9
Licensed in
GA
In the registry since
2017
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Practice location Address checks out

400 Tower Rd NE Ste 200
Marietta, GA 30060-9412
Phone: (770) 422-1372
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 12345 Mercy Blvd, Savannah, GA 31419-3436 — (912) 927-3046

Specialties & licences

Acute Care Nurse Practitioner (primary) Taxonomy 363LA2100X · Licence 236517 (GA)

Record details

NPI number1700308509
Entity typeIndividual (Type 1)
GenderFemale
Credentials AGACNP
Sole proprietorNo
NPI enumeratedJuly 13, 2017
Last updated in NPPESMarch 28, 2025
Certification dateMarch 28, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Wellstar Medical Group Llc — 3072 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations6 on file with Medicare

Other providers in Marietta