Healthcare Provider Details

I. General information

NPI: 1164966537
Provider Name (Legal Business Name): TIFFANY'S HOMECARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2016
Last Update Date: 12/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 SW COUNTY ROAD 242A
LAKE CITY FL
32025-2119
US

IV. Provider business mailing address

733 SW COUNTY ROAD 242A
LAKE CITY FL
32025-2119
US

V. Phone/Fax

Practice location:
  • Phone: 386-292-1994
  • Fax:
Mailing address:
  • Phone: 386-292-1994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY DENISE WATSON
Title or Position: MANAGER
Credential:
Phone: 386-292-1994