Provider Demographics
NPI:1740648195
Name:WEBB, TIFFANY RENEE (PA)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:RENEE
Last Name:WEBB
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:TIFFANY
Other - Middle Name:RENEE
Other - Last Name:OWENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 122338
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75312-2338
Mailing Address - Country:US
Mailing Address - Phone:281-875-8428
Mailing Address - Fax:281-874-0212
Practice Address - Street 1:18059 HIGHWAY 105 W STE 115
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-5001
Practice Address - Country:US
Practice Address - Phone:936-582-7000
Practice Address - Fax:936-582-7001
Is Sole Proprietor?:No
Enumeration Date:2016-01-31
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK135420363AS0400X
TXPA10380363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1688689Medicaid