MEDICARE: TIFFANY'S HOMEMAKER AND COMPANION

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251E00000X	Home Health Agency
2	251G00000X	Community Based Hospice Care Agency
3	291U00000X	Clinical Medical Laboratory
4	253Z00000X	In Home Supportive Care Agency

Other Identifiers

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

General Provider Information

NPI Number	:	1205479342
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIFFANY'S HOMEMAKER AND COMPANION

Provider Business Mailing Address
First Line	:	11039 COLONIAL TAVERN LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32221-2123
Country	:	US
Telephone Number	:	904-450-1430
Fax Number	:

Provider Business Practice Location Address
First Line	:	11039 COLONIAL TAVERN LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32221-2123
Country	:	US
Telephone Number	:	904-450-1430
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TIFFANY MCKENNON
Credential	:
Telephone Number	:	904-450-1430

Provider Enumeration Date	:	10/22/2019
Last Update Date	:	03/28/2022

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