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General NPI Number Information
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NPI Number | 1417558040
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Entity Type | Individual
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Provider Name | TIFFANY A GOMMEL MSW, RCSWI
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Gender | Female
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Dates
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Enumeration Date | 11/02/2020
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 1530 CORNERSTONE BLVD STE 100
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-7129
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Country | US
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Telephone | 386-304-7600
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Fax |
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Provider Business Mailing Address
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Address Line | 207 SANTA CRUZ ST
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City | EAST PALATKA
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State | FL
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Zip | 32131-2154
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Country | US
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Telephone | 386-240-8242
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | ISW21955
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License Number State | FL
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