Individual
TIFFANY LEAH CLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN-ANP
Contact information
Practice address
712 N. WASHINGTON AVE, SUITE 415, DALLAS, TX 75246-1800
(214) 820-9115
(214) 820-9135
Mailing address
712 N WASHINGTON AVE, SUITE 415, DALLAS, TX 75246-1619
(214) 820-9115
(214) 820-9135
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
765246
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
294800201
—
TX
Enumeration date
02/23/2012
Last updated
03/30/2022
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