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NPI Code Detail

MEDICARE: TIFFANY MOORE

MEDICARE: TIFFANY MOORE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-18-49175FL
2106E00000XAssistant Behavior Analyst

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083114698
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANY MOORE
Provider Business Mailing Address
First Line : PO BOX 93374
Second Line :
City : LAKELAND
State : FL
Zip : 33804-3374
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 600 LAKE HOLLINGSWORTH DR
Second Line :
City : LAKELAND
State : FL
Zip : 33803-2364
Country : US
Telephone Number : 863-665-7300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2018
Last Update Date : 05/26/2022

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Directions to “ TIFFANY MOORE ” Practice Location

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