Provider Demographics
NPI:1740630987
Name:VANGUNDY, TIFFANY (MPAS)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:VANGUNDY
Suffix:
Gender:F
Credentials:MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 REGENCY PKWY
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5167
Mailing Address - Country:US
Mailing Address - Phone:817-261-1122
Mailing Address - Fax:
Practice Address - Street 1:130 REGENCY PKWY
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5167
Practice Address - Country:US
Practice Address - Phone:817-261-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-19
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant