Healthcare Provider Details

I. General information

NPI: 1104331792
Provider Name (Legal Business Name): TIFFANY HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 03/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 CALHOUN AVE
SEFFNER FL
33584-3617
US

IV. Provider business mailing address

PO BOX 1771
SEFFNER FL
33583-1771
US

V. Phone/Fax

Practice location:
  • Phone: 813-473-9510
  • Fax: 813-435-3246
Mailing address:
  • Phone: 813-473-9510
  • Fax: 813-435-3246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number23494
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: