Provider Demographics
NPI:1750565099
Name:MUIRHEAD, TIFFANY MICHELLE (LPN, MHA)
Entity type:Individual
Prefix:MISS
First Name:TIFFANY
Middle Name:MICHELLE
Last Name:MUIRHEAD
Suffix:
Gender:F
Credentials:LPN, MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5410 VERDUGOS PALACE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78244-2353
Mailing Address - Country:US
Mailing Address - Phone:419-297-5243
Mailing Address - Fax:
Practice Address - Street 1:5410 VERDUGOS PALACE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78244-2353
Practice Address - Country:US
Practice Address - Phone:419-297-5243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-21
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH125525164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse