Provider Demographics
NPI:1669710729
Name:LAWRENCE, TIFFANY AMARIS
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:AMARIS
Last Name:LAWRENCE
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 1:21550 PROVINCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-7560
Mailing Address - Country:US
Mailing Address - Phone:347-736-4059
Mailing Address - Fax:
Practice Address - Street 1:21550 PROVINCIAL BLVD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-7560
Practice Address - Country:US
Practice Address - Phone:347-736-4059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-24
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula