Healthcare Provider Details

I. General information

NPI: 1376063404
Provider Name (Legal Business Name): TIFFANI HORNE BS RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 06/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4885 S 900 E STE 107
SALT LAKE CITY UT
84117-3905
US

IV. Provider business mailing address

4531 S 2025 W
ROY UT
84067-3307
US

V. Phone/Fax

Practice location:
  • Phone: 801-266-0399
  • Fax: 801-266-0421
Mailing address:
  • Phone: 801-814-2127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number4861666-5701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: