Provider Demographics
NPI:1336194877
Name:BOULD, TIFFANY E (FNP-C,APRN)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:E
Last Name:BOULD
Suffix:
Gender:F
Credentials:FNP-C,APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1293 ELDRIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-1670
Mailing Address - Country:US
Mailing Address - Phone:832-486-1484
Mailing Address - Fax:832-486-5710
Practice Address - Street 1:4250 CONGRESS ST STE 900
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-0044
Practice Address - Country:US
Practice Address - Phone:980-299-5644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126895363LF0000X
NC5015144363LX0106X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P71457Medicare UPIN