Provider Demographics
NPI:1780153775
Name:JOCO, TIFFANY (AGACNP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:JOCO
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 E BROAD ST STE 318
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6413
Mailing Address - Country:US
Mailing Address - Phone:817-779-3178
Mailing Address - Fax:844-292-1460
Practice Address - Street 1:2800 E BROAD ST STE 318
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-6413
Practice Address - Country:US
Practice Address - Phone:817-779-3178
Practice Address - Fax:844-292-1460
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138439363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care