Healthcare Provider Details

I. General information

NPI: 1114379831
Provider Name (Legal Business Name): DAVID TIGTIG FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 05/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 MEDICAL PLAZA DR STE 520
SHENANDOAH TX
77380
US

IV. Provider business mailing address

920 MEDICAL PLAZA DR STE 520
SHENANDOAH TX
77380-3204
US

V. Phone/Fax

Practice location:
  • Phone: 832-562-3974
  • Fax: 832-663-9378
Mailing address:
  • Phone: 832-562-3974
  • Fax: 832-663-6378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP131364
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: