Individual
TIFFANY M MATTOX-RUBIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
4985 FOREST HILL RD S, OLIVE BRANCH, MS 38654-6008
(901) 282-5531
Mailing address
4985 FOREST HILL RD S, OLIVE BRANCH, MS 38654-6008
(901) 282-5531
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
30562
TN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
904963
MS
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
95022775
CA
Other
Enumeration date
04/20/2018
Last updated
10/29/2025
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