Healthcare Provider Details

I. General information

NPI: 1699607242
Provider Name (Legal Business Name): TIFFANI BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801A PARK DR UNIT 107
WARNER ROBINS GA
31088-5174
US

IV. Provider business mailing address

801A PARK DR UNIT 107
WARNER ROBINS GA
31088-5174
US

V. Phone/Fax

Practice location:
  • Phone: 229-202-7234
  • Fax: 888-765-7033
Mailing address:
  • Phone: 229-202-7234
  • Fax: 888-765-7033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN206942
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: