MEDICARE: TIFFANY CHANTELL BRINTLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	MI000031602

General Provider Information

NPI Number	:	1093503898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY CHANTELL BRINTLEY

Provider Business Mailing Address
First Line	:	22430 COLUMBUS AVE
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48089-2746
Country	:	US
Telephone Number	:	248-897-6661
Fax Number	:

Provider Business Practice Location Address
First Line	:	22430 COLUMBUS AVE
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48089-2746
Country	:	US
Telephone Number	:	248-897-6661
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2025
Last Update Date	:	04/30/2025

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Directions to “ TIFFANY CHANTELL BRINTLEY ” Practice Location

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