Provider Demographics
NPI:1508753112
Name:ROBERTSON, TIFFANY
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:ROBERTSON
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 1:101 SWEET GUM ST
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-0140
Mailing Address - Country:US
Mailing Address - Phone:972-814-2009
Mailing Address - Fax:972-814-2009
Practice Address - Street 1:101 SWEET GUM ST
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154-0140
Practice Address - Country:US
Practice Address - Phone:972-814-2009
Practice Address - Fax:972-814-2009
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX704531163WP0808X, 163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health