Healthcare Provider Details

I. General information

NPI: 1942464193
Provider Name (Legal Business Name): MS. TIFFANY D MONROE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 S PIKE E STE 1C
SUMTER SC
29150-2131
US

IV. Provider business mailing address

8512 SILVER RD
MANNING SC
29102-8260
US

V. Phone/Fax

Practice location:
  • Phone: 803-848-4015
  • Fax: 803-848-4015
Mailing address:
  • Phone: 803-696-6212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: