Provider Demographics
NPI:1184420846
Name:BLUE-DIAZ, TIFFANY DAWN
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:DAWN
Last Name:BLUE-DIAZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:BLUE-DIAZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6840 E 57TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-8514
Mailing Address - Country:US
Mailing Address - Phone:720-436-5936
Mailing Address - Fax:
Practice Address - Street 1:6655 S YALE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3326
Practice Address - Country:US
Practice Address - Phone:918-481-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0132298163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health