Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP135306 | TX |
NPI | 1033629134 |
---|---|
Provider Name | Tiffany Marie Woods |
First Address | Fort Worth, TX 76107-7277 |
Second Address | Grapevine, TX 76051-6900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2017 |
Last Update Date | 16/10/2018 |