MEDICARE: TIFFINEY MCMAKIN 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	363LF0000X	Family Nurse Practitioner	AP142509	TX

General Provider Information

NPI Number	:	1679116610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFINEY MCMAKIN NP

Provider Business Mailing Address
First Line	:	501 SAUNDERS AVE
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75702-7522
Country	:	US
Telephone Number	:	903-579-9800
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 SAUNDERS AVE
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75702-7522
Country	:	US
Telephone Number	:	903-579-9800
Fax Number	:

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

Provider Enumeration Date	:	10/22/2019
Last Update Date	:	09/28/2023

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