Provider Demographics
NPI:1578237442
Name:STAGE, TIFFANY RENEE (NP -C)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:RENEE
Last Name:STAGE
Suffix:
Gender:F
Credentials:NP -C
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:RENEE
Other - Last Name:RAGON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-254-7211
Mailing Address - Fax:
Practice Address - Street 1:706 AVENUE G
Practice Address - Street 2:
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-5866
Practice Address - Country:US
Practice Address - Phone:830-201-8900
Practice Address - Fax:830-201-8990
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1045567363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health