MEDICARE: TIFFANI SMITH

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1205639523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANI SMITH

Provider Business Mailing Address
First Line	:	3203 N DOWNER AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-3153
Country	:	US
Telephone Number	:	414-745-2587
Fax Number	:

Provider Business Practice Location Address
First Line	:	8885 S 68TH ST
Second Line	:
City	:	FRANKLIN
State	:	WI
Zip	:	53132-8202
Country	:	US
Telephone Number	:	414-745-2587
Fax Number	:

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

Provider Enumeration Date	:	03/31/2025
Last Update Date	:	03/31/2025

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Directions to “ TIFFANI SMITH ” Practice Location

Language	Start Address	Practice Location

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