Provider Demographics
NPI:1578239885
Name:MARTIN, TIFFANY DIANE (APRN, WHNP-BC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:DIANE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:APRN, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1924 PINE ST STE 401B
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2452
Mailing Address - Country:US
Mailing Address - Phone:325-670-4242
Mailing Address - Fax:325-670-3049
Practice Address - Street 1:201 WALLS DR STE 501
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-4006
Practice Address - Country:US
Practice Address - Phone:817-697-4220
Practice Address - Fax:325-670-3049
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1034521363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health