Healthcare Provider Details

I. General information

NPI: 1609525286
Provider Name (Legal Business Name): TIFFANY DEVEREAUX RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2833 ROBIN HILL LN
GARLAND TX
75044-5949
US

IV. Provider business mailing address

5435 N GARLAND AVE # 140137
GARLAND TX
75040-2785
US

V. Phone/Fax

Practice location:
  • Phone: 972-978-1965
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number702480
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: