Provider Demographics
NPI:1194458877
Name:CRENSHAW, TIFFANY NICOLE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:NICOLE
Last Name:CRENSHAW
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 COUNTY ROAD 1040
Mailing Address - Street 2:
Mailing Address - City:COOPER
Mailing Address - State:TX
Mailing Address - Zip Code:75432-8519
Mailing Address - Country:US
Mailing Address - Phone:940-768-9839
Mailing Address - Fax:
Practice Address - Street 1:1339 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-4895
Practice Address - Country:US
Practice Address - Phone:903-951-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-08
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1087041363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily