Healthcare Provider Details

I. General information

NPI: 1851967145
Provider Name (Legal Business Name): TIFFANI BRIANA BROOKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3060 MELALEUCA LN
PALM SPRINGS FL
33461-5174
US

IV. Provider business mailing address

356 NW 11TH ST APT 2
BELLE GLADE FL
33430-2963
US

V. Phone/Fax

Practice location:
  • Phone: 561-357-7200
  • Fax:
Mailing address:
  • Phone: 561-985-8433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9562858
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: