Healthcare Provider Details

I. General information

NPI: 1639097728
Provider Name (Legal Business Name): TIFFANI TRIMM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 PETERSON PL
SANFORD FL
32773-5502
US

IV. Provider business mailing address

1445 PETERSON PL
SANFORD FL
32773-5502
US

V. Phone/Fax

Practice location:
  • Phone: 386-337-2358
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-537685
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: