MEDICARE: TIFFANY A JONES RDH

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	124Q00000X	Dental Hygienist	7249	NC

General Provider Information

NPI Number	:	1871585448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY A JONES RDH

Provider Business Mailing Address
First Line	:	5277 MAGNOLIA CIR N
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-5234
Country	:	US
Telephone Number	:	904-743-0468
Fax Number	:

Provider Business Practice Location Address
First Line	:	USS JOHN F. KENNEDY CV-67
Second Line	:	1562 MITSCHER AVE SUITE 250
City	:	NORFOLK
State	:	VA
Zip	:	23551-0001
Country	:	US
Telephone Number	:	904-270-5602
Fax Number	:

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

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	07/08/2007

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