Healthcare Provider Details

I. General information

NPI: 1659200889
Provider Name (Legal Business Name): TIFFANY NICOLE SETLIFF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

937 DIXON BLVD
COCOA FL
32922-6806
US

IV. Provider business mailing address

4851 ALFRED ST
COCOA FL
32927-3310
US

V. Phone/Fax

Practice location:
  • Phone: 321-446-2113
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH27690
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: