Provider Demographics
NPI:1205669454
Name:GRAVADOR-FLORES, TIFFANY ROSE (FNP-BC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ROSE
Last Name:GRAVADOR-FLORES
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 SANTA FABIOLA ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-0520
Mailing Address - Country:US
Mailing Address - Phone:956-897-2359
Mailing Address - Fax:
Practice Address - Street 1:4500 SANTA FABIOLA ST
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-0520
Practice Address - Country:US
Practice Address - Phone:956-897-2359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2024060286363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily