Healthcare Provider Details

I. General information

NPI: 1003245218
Provider Name (Legal Business Name): TIFFANY SHEA THOMPSON RNC, NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. TIFFANY SHEA RIBORDY

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S COULTER ST
AMARILLO TX
79106-1786
US

IV. Provider business mailing address

1400 S COULTER ST
AMARILLO TX
79106-1786
US

V. Phone/Fax

Practice location:
  • Phone: 806-414-9180
  • Fax: 806-354-5536
Mailing address:
  • Phone: 806-414-9180
  • Fax: 806-354-5536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number720968
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number720968
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberAP124774
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: