Individual
TIFFANY ANN TACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
6701 HERITAGE PKWY STE 165, ROCKWALL, TX 75087-8700
(469) 786-5890
Mailing address
6701 HERITAGE PKWY STE 165, ROCKWALL, TX 75087-8700
(469) 786-5890
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
957191
TX
Other
Enumeration date
07/17/2019
Last updated
03/02/2020
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