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General NPI Number Information
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NPI Number | 1700373115
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Entity Type | Individual
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Provider Name | TIFFANY M MATTOX-RUBIN RN
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Gender | Female
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Dates
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Enumeration Date | 04/20/2018
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 4985 FOREST HILL RD S
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-6008
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Country | US
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Telephone | 901-282-5531
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Fax |
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Provider Business Mailing Address
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Address Line | 4985 FOREST HILL RD S
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-6008
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Country | US
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Telephone | 901-282-5531
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95022775
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 904963
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 30562
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License Number State | TN
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