Healthcare Provider Details

I. General information

NPI: 1205764081
Provider Name (Legal Business Name): TIFFANY SAGE STONE DNP, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N MCKINNEY ST STE H
SWEENY TX
77480-2800
US

IV. Provider business mailing address

124 MISTLETOE ST
LAKE JACKSON TX
77566-4178
US

V. Phone/Fax

Practice location:
  • Phone: 979-548-1500
  • Fax:
Mailing address:
  • Phone: 979-548-1845
  • Fax: 979-548-1837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1242028
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: