Healthcare Provider Details

I. General information

NPI: 1487883526
Provider Name (Legal Business Name): TIFFANY JOYCE BRILINSKI IDMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2009
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N 1ST ST
ALTUS AFB OK
73523-5005
US

IV. Provider business mailing address

1813 WHITE TAIL CIR
ALTUS OK
73521-7806
US

V. Phone/Fax

Practice location:
  • Phone: 580-481-5230
  • Fax:
Mailing address:
  • Phone: 707-592-8357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: