Provider Demographics
NPI:1861744120
Name:LEAKE, TIFFANY (CRNA)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:LEAKE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 HIGHLANDER BLVD STE 415
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-4346
Mailing Address - Country:US
Mailing Address - Phone:817-516-8811
Mailing Address - Fax:817-516-8444
Practice Address - Street 1:2719 VIRGINIA PKWY
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-4917
Practice Address - Country:US
Practice Address - Phone:469-625-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07005367500000X
TX815761367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered