Healthcare Provider Details

I. General information

NPI: 1104199801
Provider Name (Legal Business Name): TIFFANY TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2012
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N ORATON PKWY APT B1
EAST ORANGE NJ
07017-4330
US

IV. Provider business mailing address

120 N ORATON PKWY APT B1
EAST ORANGE NJ
07017-4330
US

V. Phone/Fax

Practice location:
  • Phone: 973-592-4082
  • Fax:
Mailing address:
  • Phone: 973-592-4082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR22814200
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: