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Contact Information

TIFFANY D LUTTRELL, CRNA
800 E DAWSON ST
TYLER, TX75701
 Phone: 903-606-4522
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Nurse Anesthetist, Certified Registered

367500000X 43 Certified Registered Nurse Anesthetist (CRNA)
 

Registered Nurse

163W00000X
Indicates primary specialty

NPI Profile & details for TIFFANY D LUTTRELL · (Female)

NPI Number 1982902888
Status Active
Credentials CRNA (Certified Registered Nurse Anesthetist)
Entity Individual
Enumeration date 03/02/2011
Last updated 11/22/2019 - About 7 years ago
Sole proprietor 1 No
Identifiers
  • TX License # 652703
  • TX License # AP120053
  • TX Medicaid 280097104
  • TX Medicaid 280097105
  • TX Other 8512UE BCBS
  • TX Other 8512UE BCBS BLUE
  • TX Other P01196965 MCRR
  • TX Other 291790YN3X MEDICARE
  • TX Other 291790YQ8A MEDICARE
  • TX Other P01877246 MEDICARE RAIL ROAD
  • TX Other P01196965 RAIL ROAD
  • TX Other 75-0818167-015 TRICARE
  • TX Other 75-2771569-008 TRICARE
Hospital affiliation(s)
  • MOTHER FRANCES HOSPITAL - (Acute Care)
    800 EAST DAWSON
    TYLER, TX 75701
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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