1255884920 NPI number — TIFFANY OATES FNP

Table of content: TIFFANY OATES FNP (NPI 1255884920)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255884920 NPI number — TIFFANY OATES FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OATES
Provider First Name:
TIFFANY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255884920
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
409 GLENWOOD ST STE 500
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLEN ROSE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76043-4933
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-897-2202
Provider Business Mailing Address Fax Number:
254-897-1638

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1021 HOLDEN ST STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLEN ROSE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76043-4937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-897-1645
Provider Business Practice Location Address Fax Number:
254-897-1638
Provider Enumeration Date:
07/29/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  R189727 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP2300X , with the licence number: 1043835 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)