MEDICARE: TIPHANI MOORE NP

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	363LP2300X	Primary Care Nurse Practitioner	1142467	TX

General Provider Information

NPI Number	:	1053191569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIPHANI MOORE NP

Provider Business Mailing Address
First Line	:	1108 LAVACA ST STE 110-320
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78701-2172
Country	:	US
Telephone Number	:	512-477-4088
Fax Number	:	512-482-0390

Provider Business Practice Location Address
First Line	:	1108 LAVACA ST STE 110-320
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78701-2172
Country	:	US
Telephone Number	:	512-477-4088
Fax Number	:	512-482-0390

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

Provider Enumeration Date	:	10/02/2023
Last Update Date	:	03/10/2026

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