Individual
DR. TIFFANY KATHLEEN STREET
Active
Individual
DR. TIFFANY KATHLEEN STREET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
140026
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
188443901
—
TX
05
—
188443903
—
TX
01
—
8Y2118
BLUE CROSS BLUE SHIELD
TX
01
—
P00633956
RAILROAD MEDICARE
TX
Enumeration date
06/27/2007
Last updated
03/29/2022
Update your record
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