Provider Demographics
NPI:1215434642
Name:ARRIAZOLA, TIFFANI DAWN (AGNP-C)
Entity type:Individual
Prefix:
First Name:TIFFANI
Middle Name:DAWN
Last Name:ARRIAZOLA
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18333 EGRET BAY BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3239
Mailing Address - Country:US
Mailing Address - Phone:281-332-3001
Mailing Address - Fax:281-332-3005
Practice Address - Street 1:18333 EGRET BAY BLVD STE 140
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3239
Practice Address - Country:US
Practice Address - Phone:281-332-3001
Practice Address - Fax:281-332-3005
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX772609163W00000X
TXAP137282363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8JG642OtherBCBS
TX385955501Medicaid
TX8JG642OtherBCBS