Provider Demographics
NPI:1700247285
Name:WILSON, TIFFANY ELIZABETH (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:ELIZABETH
Last Name:WILSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8441 STATE HWY 47
Mailing Address - Street 2:STE 3115
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77807-0001
Mailing Address - Country:US
Mailing Address - Phone:979-436-9703
Mailing Address - Fax:979-436-9703
Practice Address - Street 1:1602 ROCK PRAIRIE RD
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-8306
Practice Address - Country:US
Practice Address - Phone:979-693-0737
Practice Address - Fax:979-693-7442
Is Sole Proprietor?:No
Enumeration Date:2016-03-11
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130206363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2G3166OtherMEDICARE PTAN