Provider Demographics
NPI:1902090798
Name:SCOTT, TIFFANI LYN (RN, MSN, CPNP)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANI
Middle Name:LYN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:RN, MSN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1464 E WHITESTONE BLVD
Mailing Address - Street 2:201
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-9058
Mailing Address - Country:US
Mailing Address - Phone:512-260-8100
Mailing Address - Fax:512-260-8103
Practice Address - Street 1:1464 E WHITESTONE BLVD
Practice Address - Street 2:201
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-9058
Practice Address - Country:US
Practice Address - Phone:512-260-8100
Practice Address - Fax:512-260-8103
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX710481363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX218614004Medicaid
TX218614003Medicaid
TX21861403Medicaid
TX218614002Medicaid