MEDICARE: TIFFANY NICOLE DAVIS

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	343900000X	Non-emergency Medical Transport (VAN)	04386829	TX

General Provider Information

NPI Number	:	1154131217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY NICOLE DAVIS

Provider Business Mailing Address
First Line	:	12810 ROCKFORD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77048-4162
Country	:	US
Telephone Number	:	832-341-2367
Fax Number	:

Provider Business Practice Location Address
First Line	:	12810 ROCKFORD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77048-4162
Country	:	US
Telephone Number	:	832-341-2367
Fax Number	:

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

Provider Enumeration Date	:	01/10/2025
Last Update Date	:	01/10/2025

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Directions to “ TIFFANY NICOLE DAVIS ” Practice Location

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