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1538302070 NPI number — TIFFANY NICOLE RYBAK CRNP

NPI Number: 1538302070
Health Care Provider/Practitioner: TIFFANY NICOLE RYBAK CRNP

Information about “1538302070” NPI (TIFFANY NICOLE RYBAK CRNP) exists in 1538302070 in HTML format HTML  |  1538302070 in plain Text format TXT  |  1538302070 in PDF (Portable Document Format) PDF  |  1538302070 in an XML format XML  formats.

NPI Number : 1538302070 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1538302070",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "RYBAK",
    "FirstName": "TIFFANY",
    "MiddleName": "NICOLE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "CRNP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2423 WILLIAMS DR STE 107",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GEORGETOWN",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "78628-3269",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "877-800-5722",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3950 N A W GRIMES BLVD STE N201",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ROUND ROCK",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "78665-3540",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "877-800-5722",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/14/2009",
    "LastUpdateDate": "06/11/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "163WP0200X",
          "TaxonomyName": "Pediatric Registered Nurse",
          "LicenseNumber": "COA13571NP",
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LP0200X",
          "TaxonomyName": "Pediatric Nurse Practitioner",
          "LicenseNumber": "COA-13571",
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LP0200X",
          "TaxonomyName": "Pediatric Nurse Practitioner",
          "LicenseNumber": "1198422",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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