Healthcare Provider Details

I. General information

NPI: 1306777024
Provider Name (Legal Business Name): TIFFANY MILLER
Entity Type: Individual
Gender:
Sole Proprietor: N

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

35229 BRISTLECONE
CLINTON TWP MI
48035-2318
US

IV. Provider business mailing address

35229 BRISTLECONE
CLINTON TWP MI
48035-2318
US

V. Phone/Fax

Practice location:
  • Phone: 734-787-9017
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4703122529
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: