Healthcare Provider Details

I. General information

NPI: 1548126295
Provider Name (Legal Business Name): TIFFANY LUONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2025
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5799 ANDERS WAY
SAINT CLOUD FL
34771-8133
US

IV. Provider business mailing address

5799 ANDERS WAY
SAINT CLOUD FL
34771-8133
US

V. Phone/Fax

Practice location:
  • Phone: 609-969-3333
  • Fax:
Mailing address:
  • Phone: 609-969-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number19951
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: