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General NPI Number Information
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NPI Number | 1811795180
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Entity Type | Individual
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Provider Name | TIFFANY IZOBA
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Gender | Female
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Dates
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Enumeration Date | 03/04/2025
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | PO BOX 13
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City | HUMBLE
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State | TX
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Zip | 77347-0013
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Country | US
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Telephone | 318-344-6943
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 422
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City | HUMBLE
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State | TX
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Zip | 77347-0422
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Country | US
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Telephone | 318-344-6943
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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 | 1191744
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License Number State | TX
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