MEDICARE: JEANETTE H TIFRE REGISTERED NURSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	647087	TX
2	172V00000X	Community Health Worker
3	171400000X	Health & Wellness Coach	61235924870410	TX

General Provider Information

NPI Number	:	1386325918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANETTE H TIFRE REGISTERED NURSE

Provider Business Mailing Address
First Line	:	2911 EL DORADO BLVD
Second Line	:
City	:	FRIENDSWOOD
State	:	TX
Zip	:	77546-5737
Country	:	US
Telephone Number	:	281-636-9209
Fax Number	:

Provider Business Practice Location Address
First Line	:	2911 EL DORADO BLVD
Second Line	:
City	:	FRIENDSWOOD
State	:	TX
Zip	:	77546-5737
Country	:	US
Telephone Number	:	281-636-9209
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2023
Last Update Date	:	12/08/2023

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Directions to “ JEANETTE H TIFRE REGISTERED NURSE” Practice Location

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