Provider Demographics
NPI:1720741150
Name:HOWARD, TIFFANY WYNETTE
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:WYNETTE
Last Name:HOWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5703 PEBBLE SPRINGS DR # DE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77066-2308
Mailing Address - Country:US
Mailing Address - Phone:832-618-0372
Mailing Address - Fax:
Practice Address - Street 1:5703 PEBBLE SPRINGS DR # DE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77066-2308
Practice Address - Country:US
Practice Address - Phone:832-618-0372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-21
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1032619363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care