Provider Demographics
NPI:1497503965
Name:TIPPS, TENEISHA (RN, NC-BC)
Entity type:Individual
Prefix:
First Name:TENEISHA
Middle Name:
Last Name:TIPPS
Suffix:
Gender:F
Credentials:RN, NC-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 HARLANDALE AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216-1519
Mailing Address - Country:US
Mailing Address - Phone:972-330-3746
Mailing Address - Fax:
Practice Address - Street 1:1535 HARLANDALE AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-1519
Practice Address - Country:US
Practice Address - Phone:972-330-3746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX771717163WH0500X, 171400000X, 174H00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0500XNursing Service ProvidersRegistered NurseHemodialysis
No171400000XOther Service ProvidersHealth & Wellness Coach
No174H00000XOther Service ProvidersHealth Educator