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General NPI Number Information
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NPI Number | 1356732838
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Entity Type | Individual
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Provider Name | TIFFANY RENEE CARTER PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/05/2015
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Last Update Date | 02/05/2015
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Provider Practice Location Address
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Address Line | 605 E 4TH ST STE 300
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City | ODESSA
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State | TX
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Zip | 79761-5100
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Country | US
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Telephone | 432-337-4347
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Fax | 432-337-1657
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Provider Business Mailing Address
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Address Line | 4806 SUNSHINE PKWY
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City | MIDLAND
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State | TX
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Zip | 79707-6200
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Country | US
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Telephone | 432-853-1199
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Fax | 432-337-1657
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | TX
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