Healthcare Provider Details

I. General information

NPI: 1437504321
Provider Name (Legal Business Name): TIFFANY MARIE HOFFMAN PHILLIPS M.ED, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TIFFANY M HOFFMAN

II. Dates (important events)

Enumeration Date: 04/27/2016
Last Update Date: 01/07/2023
Certification Date: 01/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N GRAND AVE
TAHLEQUAH OK
74464-2301
US

IV. Provider business mailing address

12214 BIG ROCK DR
RHOME TX
76078-6069
US

V. Phone/Fax

Practice location:
  • Phone: 918-688-2400
  • Fax:
Mailing address:
  • Phone: 918-688-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number7749
License Number StateTX

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: