TIFFANY LYNN MLODZIK APNP
NPI 1629824479
Nurse Practitioner - Family in Fond Du Lac, WI
About Tiffany Lynn Mlodzik Apnp NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
TIFFANY LYNN MLODZIK APNP (NPI 1629824479) is an individual family provider in Fond Du Lac, Wisconsin, licensed in Wisconsin (15276-33) and active in the NPI registry since April 2024. She is enrolled in Medicare PECOS, is affiliated with St. Agnes Hospital Hospice, and is a graduate of Other (2023).
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Tiffany Lynn Mlodzik Apnp is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignment
Medicare enrollment records show Tiffany Mlodzik reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Fond Du Lac, WI 54935
- Reassigned Medicare billing, Wisconsin enrollment
- 606 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Hospital Affiliations CMS Care Compare 2
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
St. Agnes Hospital Hospice
Acute Care Hospitals · Fond Du Lac, WIWaupun Memorial Hospital
Critical Access Hospitals · Waupun, WIPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 54935 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
FOND DU LAC, WI 54935
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Tiffany Mlodzik's NPI number?
The NPI number for Tiffany Mlodzik is 1629824479. It was assigned to this individual provider in the NPPES registry on April 24, 2024.
Where is Tiffany Mlodzik located?
Tiffany Mlodzik practices at 430 E Division St, Fond Du Lac, WI 54935. The listed phone number is (920) 923-7940.
What is Tiffany Mlodzik's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Tiffany Mlodzik enrolled in Medicare?
Yes. Tiffany Mlodzik is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organization bills Medicare for Tiffany Mlodzik's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Tiffany Mlodzik reassigns Medicare benefits to Agnesian Healthcare Inc (Fond Du Lac, WI). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Tiffany Mlodzik's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
Is Tiffany Mlodzik affiliated with any hospitals?
According to CMS data, Tiffany Mlodzik is affiliated with St. Agnes Hospital Hospice and Waupun Memorial Hospital.
When was this NPI record last updated?
The NPPES record for Tiffany Mlodzik was last updated on April 24, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Tiffany Lynn Mlodzik, APNP · NPI 1629824479
Family physician in Fond Du Lac, Wisconsin. Individual provider, active in the CMS NPPES registry since April 24, 2024.
## Identity
- **NPI:** 1629824479 (Entity type: Individual)
- **Enumerated:** April 24, 2024
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **State license:** 15276-33 (Wisconsin)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 430 E DIVISION ST, Fond Du Lac, WI 54935-4560
- **Phone:** (920) 923-7940
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Agnesian Healthcare Inc (NPI 1730162991, Fond Du Lac, WI), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2023
## Record status
- **NPPES last updated:** April 24, 2024
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Source: [NPI Profile](https://npiprofile.com/npi/1629824479) · Data from the CMS NPPES public registry.