Healthcare Provider Details

I. General information

NPI: 1760308258
Provider Name (Legal Business Name): MS. TIFFANY MICHELLE GORDON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6371 NW 11TH ST APT 6
SUNRISE FL
33313-6159
US

IV. Provider business mailing address

6371 NW 11TH ST APT 6
SUNRISE FL
33313-6159
US

V. Phone/Fax

Practice location:
  • Phone: 786-414-7614
  • Fax:
Mailing address:
  • Phone: 786-414-7614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number240761
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: