Healthcare Provider Details

I. General information

NPI: 1275449308
Provider Name (Legal Business Name): SERENITY OSTEOPATHIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 COCONUT RD
INDIAN HARBOUR BEACH FL
32937-5331
US

IV. Provider business mailing address

10 COCONUT RD
INDIAN HARBOUR BEACH FL
32937-5331
US

V. Phone/Fax

Practice location:
  • Phone: 678-698-9217
  • Fax:
Mailing address:
  • Phone: 678-698-9217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TIFFANY R NOBLITT
Title or Position: SOLE PROPRIETOR
Credential: DO
Phone: 678-698-9217