Healthcare Provider Details

I. General information

NPI: 1548192248
Provider Name (Legal Business Name): TIFFANY HERRMANN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TIFFANY BERKLEY

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 4TH AVE STE D
CRESTVIEW FL
32539-2401
US

IV. Provider business mailing address

4044 LAKEVIEW DR
CRESTVIEW FL
32539-8024
US

V. Phone/Fax

Practice location:
  • Phone: 850-683-3544
  • Fax:
Mailing address:
  • Phone: 817-201-7073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN31661
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: