Provider Demographics
NPI:1194225185
Name:COLE, TIFFANY (CSFA)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 BLAZING STAR TRL
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-2581
Mailing Address - Country:US
Mailing Address - Phone:214-663-1389
Mailing Address - Fax:
Practice Address - Street 1:1320 BLAZING STAR TRL
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-2581
Practice Address - Country:US
Practice Address - Phone:214-663-1389
Practice Address - Fax:214-663-1389
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant