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General NPI Number Information
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NPI Number | 1972186237
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Entity Type | Individual
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Provider Name | TIA NICOLE FLOWERS PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/04/2021
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 301 E OVILLA RD STE 100
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City | RED OAK
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State | TX
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Zip | 75154-3830
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Country | US
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Telephone | 469-800-9200
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Fax |
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Provider Business Mailing Address
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Address Line | 401 ROYAL CREST DR
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City | DESOTO
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State | TX
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Zip | 75115-1480
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Country | US
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Telephone | 469-735-0275
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | PA9116910
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9116910
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA18098
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License Number State | TX
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