Provider Demographics
NPI:1598247629
Name:TANIFORM, MARIE TEMFE THERESIA (APRN)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:TEMFE THERESIA
Last Name:TANIFORM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3608 WYCLIFF AVE
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-1646
Mailing Address - Country:US
Mailing Address - Phone:310-294-7781
Mailing Address - Fax:
Practice Address - Street 1:3608 WYCLIFF AVE
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-1646
Practice Address - Country:US
Practice Address - Phone:310-294-7781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX945551163W00000X
TX1155654363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse