Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 720968 | TX |
NPI | 1003245218 |
---|---|
Provider Name | Ms. Tiffany Shea Ribordy |
First Address | Lubbock, TX 79415-3364 |
Second Address | Lubbock, TX 79415-3364 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2013 |
Last Update Date | 14/07/2021 |