Individual
TIFFANY I MOFFETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
6621 FANNIN ST, HOUSTON, TX 77030-2303
(832) 824-0479
Mailing address
6621 FANNIN ST, HOUSTON, TX 77030-2303
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
688797
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09152
UTMB PROVIDER NUMBER
TX
Enumeration date
03/05/2007
Last updated
07/08/2007
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