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General NPI Number Information
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NPI Number | 1386558195
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Entity Type | Individual
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Provider Name | TIFFANY ANDERSON
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Gender | Female
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Dates
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Enumeration Date | 09/29/2026
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Last Update Date | 09/29/2026
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Provider Practice Location Address
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Address Line | 1149 W 84TH ST
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City | CHICAGO
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State | IL
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Zip | 60620-3106
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Country | US
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Telephone | 773-407-9586
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Fax |
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Provider Business Mailing Address
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Address Line | 4252 RESERVE WAY APT 2093
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City | IRVING
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State | TX
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Zip | 75038-9074
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Country | US
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Telephone | 708-510-8455
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Fax |
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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 | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 1071664
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License Number State | TX
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