Healthcare Provider Details

I. General information

NPI: 1811798002
Provider Name (Legal Business Name): TIFFANY NYCOLE HALL PERSONAL CARE, CD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1297 NUCKOLDS RD
HUDDLESTON VA
24104-3530
US

IV. Provider business mailing address

1297 NUCKOLDS RD
HUDDLESTON VA
24104-3530
US

V. Phone/Fax

Practice location:
  • Phone: 434-363-6701
  • Fax:
Mailing address:
  • Phone: 434-363-6701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: