Provider Demographics
NPI:1972891364
Name:WAITES, TIFFANY M (FNP)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:M
Last Name:WAITES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 GASTON AVE
Mailing Address - Street 2:BARNETT TOWER, STE 605
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1800
Mailing Address - Country:US
Mailing Address - Phone:214-820-7227
Mailing Address - Fax:214-820-7227
Practice Address - Street 1:3600 GASTON AVE
Practice Address - Street 2:BARNETT TOWER, STE 605
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1800
Practice Address - Country:US
Practice Address - Phone:214-820-7227
Practice Address - Fax:214-820-7227
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX808586363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX285924101Medicaid
TXTXB138550Medicare PIN
TX285924101Medicaid
TXTXB164141Medicare PIN
TXTXB164139Medicare PIN