Provider Demographics
NPI:1386275600
Name:LINZY, TIFFANY P (CPRSS)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:P
Last Name:LINZY
Suffix:
Gender:F
Credentials:CPRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5505 MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-5508
Mailing Address - Country:US
Mailing Address - Phone:405-796-1010
Mailing Address - Fax:405-609-6575
Practice Address - Street 1:8515 NE 25TH ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:OK
Practice Address - Zip Code:73084-3818
Practice Address - Country:US
Practice Address - Phone:405-796-7010
Practice Address - Fax:405-609-6575
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist