Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 102773 | OK |
NPI | 1306242573 |
---|---|
Provider Name | Tiffany Ann Tolbert |
First Address | Tulsa, OK 74136-3347 |
Second Address | Tulsa, OK 74136-1902 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2014 |
Last Update Date | 14/11/2014 |