Provider Demographics
NPI:1346049129
Name:MALCOLM, TIFFANY A (RN, CD)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:A
Last Name:MALCOLM
Suffix:
Gender:
Credentials:RN, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 BOULDER LAKE CT
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77469-2583
Mailing Address - Country:US
Mailing Address - Phone:773-272-6331
Mailing Address - Fax:
Practice Address - Street 1:1802 BOULDER LAKE CT
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77469-2583
Practice Address - Country:US
Practice Address - Phone:773-272-6331
Practice Address - Fax:713-832-0091
Is Sole Proprietor?:No
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX980331163WP1700X
IL041437581163WP1700X
TX374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No163WP1700XNursing Service ProvidersRegistered NursePerinatal