=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912715830
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TIFFANY ANN MUSTIN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/23/2024
-----------------------------------------------------
Last Update Date | 01/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | PO BOX 637 502 W DERBY ST
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68967
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-824-3283
-----------------------------------------------------
Fax | 308-824-3356
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 637 502 W DERBY ST
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68967
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-824-3283
-----------------------------------------------------
Fax | 308-824-3356
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 372600000X
-----------------------------------------------------
Taxonomy Name | Adult Companion
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------