Healthcare Provider Details

I. General information

NPI: 1417613068
Provider Name (Legal Business Name): TIFFANY ZANDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4080 N CYPRESS GREEN LN
VERO BEACH FL
32967-1007
US

IV. Provider business mailing address

4080 N CYPRESS GREEN LN
VERO BEACH FL
32967-1007
US

V. Phone/Fax

Practice location:
  • Phone: 772-501-2478
  • Fax:
Mailing address:
  • Phone: 772-501-2478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: