MEDICARE: TIFFANY DAWN SHADLE FNP-C

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	667580	TX

General Provider Information

NPI Number	:	1750560298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY DAWN SHADLE FNP-C

Provider Business Mailing Address
First Line	:	3023 PERRYTON PKWY STE 101
Second Line	:
City	:	PAMPA
State	:	TX
Zip	:	79065-2817
Country	:	US
Telephone Number	:	806-665-0801
Fax Number	:	806-665-8503

Provider Business Practice Location Address
First Line	:	3023 PERRYTON PKWY
Second Line	:	SUITE 101
City	:	PAMPA
State	:	TX
Zip	:	79065-2821
Country	:	US
Telephone Number	:	806-665-0801
Fax Number	:	806-665-8503

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

Provider Enumeration Date	:	11/01/2007
Last Update Date	:	12/18/2025

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