Provider Demographics
NPI:1386325918
Name:TIFRE, JEANETTE H (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:H
Last Name:TIFRE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2911 EL DORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-5737
Mailing Address - Country:US
Mailing Address - Phone:281-636-9209
Mailing Address - Fax:
Practice Address - Street 1:2911 EL DORADO BLVD
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-5737
Practice Address - Country:US
Practice Address - Phone:281-636-9209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX647087163W00000X
172V00000X
TX61235924870410171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No163W00000XNursing Service ProvidersRegistered Nurse
No172V00000XOther Service ProvidersCommunity Health Worker