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NPI Code Detail

MEDICARE: TIFFANY GODWIN

MEDICARE: TIFFANY GODWIN
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
1133V00000XRegistered DietitianDT86596TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DT86596OTHERTXTEXAS DEPARTMENT OF LICENSING AND REGULATION

General Provider Information

NPI Number : 1427667914
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANY GODWIN
Provider Business Mailing Address
First Line : 2701 SHORELINE DR STE 151
Second Line :
City : DENTON
State : TX
Zip : 76210-0176
Country : US
Telephone Number : 940-222-2399
Fax Number :
Provider Business Practice Location Address
First Line : 2701 SHORELINE DR STE 151
Second Line :
City : DENTON
State : TX
Zip : 76210-0176
Country : US
Telephone Number : 940-222-2399
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2020
Last Update Date : 07/30/2020

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Directions to “ TIFFANY GODWIN ” Practice Location

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