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NPI Code Detail

MEDICARE: MS. TIFFANY LYNN WHITE FNP

MEDICARE: MS. TIFFANY LYNN WHITE FNP
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
1363LF0000XFamily Nurse PractitionerF0913312TX

General Provider Information

NPI Number : 1235564873
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TIFFANY LYNN WHITE FNP
Provider Business Mailing Address
First Line : 5603 JEFF DAVIS AVE
Second Line : UNIT A
City : AUSTIN
State : TX
Zip : 78756-1223
Country : US
Telephone Number : 713-614-8878
Fax Number :
Provider Business Practice Location Address
First Line : 2610 LAKE AUSTIN BLVD
Second Line :
City : AUSTIN
State : TX
Zip : 78703-4429
Country : US
Telephone Number : 713-614-8878
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2013
Last Update Date : 09/12/2013

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