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General NPI Number Information
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NPI Number | 1992550487
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Entity Type | Individual
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Provider Name | MS. TIFFANY BROUGHTON
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Gender | Female
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Dates
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Enumeration Date | 04/18/2024
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Last Update Date | 04/18/2024
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Provider Practice Location Address
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Address Line | 4918 BELFAIR CT
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City | MOSS POINT
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State | MS
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Zip | 39563-6212
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Country | US
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Telephone | 228-235-0852
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Fax |
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Provider Business Mailing Address
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Address Line | 4918 BELFAIR CT
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City | MOSS POINT
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State | MS
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Zip | 39563-6212
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Country | US
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Telephone | 228-235-0852
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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 | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number | 1001459
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License Number State | MS
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