Provider Demographics
NPI:1275015752
Name:MAY, TIFFANY DIANE
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:DIANE
Last Name:MAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 MARINA BAY DR APT 204
Mailing Address - Street 2:
Mailing Address - City:KEMAH
Mailing Address - State:TX
Mailing Address - Zip Code:77565-2479
Mailing Address - Country:US
Mailing Address - Phone:183-222-5213
Mailing Address - Fax:
Practice Address - Street 1:1201 BLUEBERRY LN
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-5210
Practice Address - Country:US
Practice Address - Phone:281-992-2113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211814164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse