Provider Demographics
NPI:1912715830
Name:MUSTIN, TIFFANY ANN
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANN
Last Name:MUSTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:ANN
Other - Last Name:QUINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 637
Mailing Address - Street 2:502 W DERBY ST
Mailing Address - City:OXFORD
Mailing Address - State:NE
Mailing Address - Zip Code:68967
Mailing Address - Country:US
Mailing Address - Phone:308-824-3283
Mailing Address - Fax:308-824-3356
Practice Address - Street 1:PO BOX 637
Practice Address - Street 2:502 W DERBY ST
Practice Address - City:OXFORD
Practice Address - State:NE
Practice Address - Zip Code:68967
Practice Address - Country:US
Practice Address - Phone:308-824-3283
Practice Address - Fax:308-824-3356
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-23
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion