Healthcare Provider Details

I. General information

NPI: 1063803146
Provider Name (Legal Business Name): TIFFANY MARIE NGO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2015
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6475 S YALE AVE STE 400
TULSA OK
74136-7818
US

IV. Provider business mailing address

6600 S YALE AVE STE 1400
TULSA OK
74136-3331
US

V. Phone/Fax

Practice location:
  • Phone: 918-502-9600
  • Fax: 918-502-9610
Mailing address:
  • Phone: 888-247-0125
  • Fax: 918-502-8210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number82905
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: