Provider Demographics
NPI:1528600418
Name:MOYA, TIFFANY VANESSA (LVN)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:VANESSA
Last Name:MOYA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:VANESSA
Other - Last Name:SANCHEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:13915 BURNET RD STE 303
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78728-6505
Mailing Address - Country:US
Mailing Address - Phone:512-996-9559
Mailing Address - Fax:
Practice Address - Street 1:13915 BURNET RD STE 303
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78728-6505
Practice Address - Country:US
Practice Address - Phone:512-996-9559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX334957164W00000X, 164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse