MEDICARE: TIFFANY HATCH RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WH0200X	Home Health Registered Nurse	822104	TX
2	207RI0001X	Clinical & Laboratory Immunology (Internal Medicine) Physician	822104	TX
3	363LP2300X	Primary Care Nurse Practitioner	822104	TX

General Provider Information

NPI Number	:	1053132167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY HATCH RN

Provider Business Mailing Address
First Line	:	3220 KIRBY DR STE 140
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-5549
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3220 KIRBY DR STE 140
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-5549
Country	:	US
Telephone Number	:	409-543-4426
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2024
Last Update Date	:	10/22/2024

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