Individual
TIFFANY SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1500 CIRCLE DR, FORT WORTH, TX 76119
(817) 423-6320
Mailing address
4309 KYLEIGH DR, FORT WORTH, TX 76123
(817) 879-1139
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
703688
TX
Other
Enumeration date
06/20/2014
Last updated
06/20/2014
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