Provider Demographics
NPI:1427839620
Name:FICHTENBERG, TIFFANY LOY
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LOY
Last Name:FICHTENBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 S ELWOOD AVE APT 200
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74119-1033
Mailing Address - Country:US
Mailing Address - Phone:918-519-1947
Mailing Address - Fax:
Practice Address - Street 1:6111 E SKELLY DR
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6100
Practice Address - Country:US
Practice Address - Phone:918-510-4054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist