Healthcare Provider Details

I. General information

NPI: 1386107977
Provider Name (Legal Business Name): TIFFANY I BORROMEO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11901 TOEPPERWEIN RD STE 1401
LIVE OAK TX
78233-3160
US

IV. Provider business mailing address

11901 TOEPPERWEIN RD STE 1401
LIVE OAK TX
78233-3160
US

V. Phone/Fax

Practice location:
  • Phone: 210-599-1433
  • Fax: 210-599-1803
Mailing address:
  • Phone: 210-599-1433
  • Fax: 210-599-1803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP140054
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: