Healthcare Provider Details

I. General information

NPI: 1548973688
Provider Name (Legal Business Name): TIFFANY SHIVER IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LITTLE LACTATION LADY IBCLC

II. Dates (important events)

Enumeration Date: 01/04/2023
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRED WILLIAMS RD
PERRY FL
32347-1127
US

IV. Provider business mailing address

75 FRED WILLIAMS RD
PERRY FL
32347-1127
US

V. Phone/Fax

Practice location:
  • Phone: 386-281-7685
  • Fax:
Mailing address:
  • Phone: 386-281-7685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-308333
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: