Healthcare Provider Details

I. General information

NPI: 1215846530
Provider Name (Legal Business Name): MRS. TIFFANY EVONNE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21755 INTERSTATE 45 N
SPRING TX
77388-3607
US

IV. Provider business mailing address

9314 RYDER DR
SAN ANTONIO TX
78254-2000
US

V. Phone/Fax

Practice location:
  • Phone: 346-200-9525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: