Tiffany Lee Boulanger, AGACNP - Medicare Nurse Practitioner in Marietta, GA

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Tiffany Lee Boulanger, AGACNP is a medicare enrolled "Nurse Practitioner - Acute Care" in Marietta, Georgia. Her current practice location is 400 Tower Rd Ne Ste 200, Marietta, Georgia. You can reach out to her office (for appointments etc.) via phone at (770) 422-1372.

Tiffany Lee Boulanger is licensed to practice in Georgia (license number 236517) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1700308509.

Contact Information

Tiffany Lee Boulanger, AGACNP
400 Tower Rd Ne Ste 200,
Marietta, GA 30060-9412
(770) 422-1372
Not Available

Map and Direction




Provider's Profile

Full NameTiffany Lee Boulanger
GenderFemale
SpecialityNurse Practitioner - Acute Care
Location400 Tower Rd Ne Ste 200, Marietta, Georgia
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1700308509
  • Provider Enumeration Date: 07/13/2017
  • Last Update Date: 03/28/2025
  Medicare PECOS Information:
  • PECOS PAC ID: 4981978376
  • Enrollment ID: I20170925000300

Medical Identifiers

Medical identifiers for Tiffany Lee Boulanger such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1700308509NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
363LA2100XNurse Practitioner - Acute Care 236517 (Georgia)Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Tiffany Lee Boulanger allows following entities to bill medicare on her behalf.
Entity NameWellstar Medical Group, Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1558664003
PECOS PAC ID: 6709065402
Enrollment ID: O20110127000374
Entity NameLeewood Medical Pc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1023416674
PECOS PAC ID: 7719204429
Enrollment ID: O20150410001714
Entity NamePruitthealth Physicians Services Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1043676299
PECOS PAC ID: 8123327061
Enrollment ID: O20160428000256
Entity NameRenew Wound Care Of Georgia Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1245907971
PECOS PAC ID: 8426454133
Enrollment ID: O20210903002161
Entity NameRegional Healthcare Group Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1407587363
PECOS PAC ID: 8224412234
Enrollment ID: O20240514002085
Entity NameGuardian Biologics Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1033890876
PECOS PAC ID: 8123481470
Enrollment ID: O20240515000530
Entity NameOld Mission Wound Care Georgia Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1841030343
PECOS PAC ID: 7012449507
Enrollment ID: O20241022004176

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Tiffany Lee Boulanger is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Tiffany Lee Boulanger, AGACNP
7400 Abercorn Street, Ste 704 Box 104,
Savannah, GA 31406-2454

Ph: (912) 232-9700		Tiffany Lee Boulanger, AGACNP
400 Tower Rd Ne Ste 200,
Marietta, GA 30060-9412

Ph: (770) 422-1372

Reviews and Comments


Nurse Practitioner Nurses in Marietta, GA

Mrs. Jennifer Irene Sarno, ACNP-BC
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Medicare: Not Enrolled in Medicare
Practice Location: 780 Canton Rd Ne, Suite 400, Marietta, GA 30060
Phone: 770-422-3602    
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Practice Location: 55 Whitcher St Ne Ste 350, Marietta, GA 30060
Phone: 770-424-6893    
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Practice Location: 55 Whitcher St Ne Ste 350, Marietta, GA 30060
Phone: 770-424-6893    Fax: 770-528-9938
Julie J Baute, APRN
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Medicare: Not Enrolled in Medicare
Practice Location: 780 Canton Rd Ne Ste 205, Marietta, GA 30060
Phone: 678-224-6198    
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Practice Location: 2481 Hurt Rd Sw, Marietta, GA 30008
Phone: 404-934-2420    
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Practice Location: 1579 Sage Ridge Dr, Marietta, GA 30064
Phone: 404-643-0444    
Ms. Trina Renee Cain, CNP
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Medicare: Medicare Enrolled
Practice Location: 811 Kennesaw Ave Nw, Marietta, GA 30060
Phone: 678-458-5311    

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.