Provider Demographics
NPI:1033895032
Name:JONES, TIFFANY R (ADMINISTRATOR)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:R
Last Name:JONES
Suffix:
Gender:F
Credentials:ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N STATE HIGHWAY 360 APT 1527
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3594
Mailing Address - Country:US
Mailing Address - Phone:972-217-2145
Mailing Address - Fax:
Practice Address - Street 1:400 N STATE HIGHWAY 360 APT 1527
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3594
Practice Address - Country:US
Practice Address - Phone:972-217-2145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX931969601376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator