Provider Demographics
NPI:1811635535
Name:DO, TIFFANY
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:DO
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:PO BOX 541223
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-1223
Mailing Address - Country:US
Mailing Address - Phone:918-810-1005
Mailing Address - Fax:
Practice Address - Street 1:APEX HEALTH
Practice Address - Street 2:505 N INTERSTATE 35
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154
Practice Address - Country:US
Practice Address - Phone:469-820-3460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40808183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist