Healthcare Provider Details

I. General information

NPI: 1215404686
Provider Name (Legal Business Name): TIFFANY GARCIA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N JEFFERSON ST BLDG SHCH
HOBBS NM
88240-5332
US

IV. Provider business mailing address

1600 N MAIN AVE
LOVINGTON NM
88260-2830
US

V. Phone/Fax

Practice location:
  • Phone: 575-433-3030
  • Fax:
Mailing address:
  • Phone: 575-396-6611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-54295
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: