Healthcare Provider Details

I. General information

NPI: 1487587309
Provider Name (Legal Business Name): TIFFANY QUIJANO LMHC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15121 E FALCONS LEA DR
DAVIE FL
33331-2923
US

IV. Provider business mailing address

15121 E FALCONS LEA DR
DAVIE FL
33331-2923
US

V. Phone/Fax

Practice location:
  • Phone: 954-665-1108
  • Fax:
Mailing address:
  • Phone: 954-665-1108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY N QUIJANO
Title or Position: OWNER
Credential:
Phone: 954-665-1108