Healthcare Provider Details

I. General information

NPI: 1881528016
Provider Name (Legal Business Name): MRS. TIFFANY COATS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4784 NW 167TH ST
MIAMI LAKES FL
33014-6427
US

IV. Provider business mailing address

17130 NW 32ND AVE
MIAMI GARDENS FL
33056-4303
US

V. Phone/Fax

Practice location:
  • Phone: 305-505-7842
  • Fax:
Mailing address:
  • Phone: 305-505-7842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License NumberSO-11-1586-GH
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: