Provider Demographics
NPI:1023444163
Name:VAUGHT, TIFFANY L (FNP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:L
Last Name:VAUGHT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:L
Other - Last Name:ROBERGE OR STONEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:605 E 4TH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-5100
Mailing Address - Country:US
Mailing Address - Phone:432-617-8329
Mailing Address - Fax:
Practice Address - Street 1:605 E 4TH ST STE 203
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5100
Practice Address - Country:US
Practice Address - Phone:432-617-8329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX663890363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily