Provider Demographics
NPI:1164424669
Name:MURPHY, TIFFANI D (PA)
Entity Type:Individual
Prefix:MS
First Name:TIFFANI
Middle Name:D
Last Name:MURPHY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:JUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:76247-0068
Mailing Address - Country:US
Mailing Address - Phone:940-648-9900
Mailing Address - Fax:940-648-1600
Practice Address - Street 1:310 W 2ND ST
Practice Address - Street 2:
Practice Address - City:JUSTIN
Practice Address - State:TX
Practice Address - Zip Code:76247-5023
Practice Address - Country:US
Practice Address - Phone:940-648-9900
Practice Address - Fax:940-648-1600
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02601363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG63378Medicare UPIN
TX8A4880Medicare ID - Type Unspecified