Provider Demographics
NPI:1730763764
Name:ISAACS, TIFFANY ANN
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANN
Last Name:ISAACS
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 1:109 ASPEN DR
Mailing Address - Street 2:
Mailing Address - City:MANNFORD
Mailing Address - State:OK
Mailing Address - Zip Code:74044-7030
Mailing Address - Country:US
Mailing Address - Phone:191-820-0154
Mailing Address - Fax:
Practice Address - Street 1:109 ASPEN DR
Practice Address - Street 2:
Practice Address - City:MANNFORD
Practice Address - State:OK
Practice Address - Zip Code:74044-7030
Practice Address - Country:US
Practice Address - Phone:191-820-0154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK000000000164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse