Healthcare Provider Details

I. General information

NPI: 1184466781
Provider Name (Legal Business Name): TIFFANY M HERRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12651 MCGREGOR BLVD STE 501C
FORT MYERS FL
33919-4496
US

IV. Provider business mailing address

3000 OASIS GRAND BLVD APT 1805
FORT MYERS FL
33916-1640
US

V. Phone/Fax

Practice location:
  • Phone: 239-839-3024
  • Fax:
Mailing address:
  • Phone: 239-839-3024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number25320
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: