Provider Demographics
NPI:1386107977
Name:BORROMEO, TIFFANY I (FNP-C)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:I
Last Name:BORROMEO
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 1:11901 TOEPPERWEIN RD STE 1401
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3160
Mailing Address - Country:US
Mailing Address - Phone:210-599-1433
Mailing Address - Fax:210-599-1803
Practice Address - Street 1:11901 TOEPPERWEIN RD STE 1401
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3160
Practice Address - Country:US
Practice Address - Phone:210-599-1433
Practice Address - Fax:210-599-1803
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140054363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP140054OtherFAMILY NURSE PRACTITIONER