Provider Demographics
NPI:1700800851
Name:MCBRIDE, TIFFANY D (FNP)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:D
Last Name:MCBRIDE
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 1:1575 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4901
Mailing Address - Country:US
Mailing Address - Phone:817-702-8759
Mailing Address - Fax:817-702-7256
Practice Address - Street 1:1575 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4901
Practice Address - Country:US
Practice Address - Phone:817-702-8759
Practice Address - Fax:817-702-7256
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6632545363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP95607Medicare UPIN
TX8C1466Medicare ID - Type Unspecified