Healthcare Provider Details

I. General information

NPI: 1215846365
Provider Name (Legal Business Name): TIFFANY STARRETTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 E TORBUSH ES DR
SALISBURY NC
28144-9568
US

IV. Provider business mailing address

419 E TORBUSH ES DR
SALISBURY NC
28144-9568
US

V. Phone/Fax

Practice location:
  • Phone: 980-233-0305
  • Fax:
Mailing address:
  • Phone: 980-233-0305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number320176
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: