Provider Demographics
NPI:1811283310
Name:MORELAND, TIFFANY B (LSA, CSFA)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:B
Last Name:MORELAND
Suffix:
Gender:F
Credentials:LSA, CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 SHASTA RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-4697
Mailing Address - Country:US
Mailing Address - Phone:936-444-7071
Mailing Address - Fax:
Practice Address - Street 1:2007 SHASTA RIDGE DR
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-4697
Practice Address - Country:US
Practice Address - Phone:936-444-7071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00639363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical