Individual
TIFFANY JETER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, CPNP-AC
Contact information
Practice address
801 7TH AVE, FORT WORTH, TX 76104-2733
(682) 885-4054
(682) 885-7497
Mailing address
PO BOX 733784, DALLAS, TX 75373-3784
(682) 885-6483
(682) 885-3113
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
1048508
TX
363LP0200X
Pediatric Nurse Practitioner
1048508
TX
Other
Enumeration date
08/10/2021
Last updated
08/07/2024
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