MEDICARE: MS. 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
1	347C00000X	Private Vehicle	2000418531	NV

General Provider Information

NPI Number	:	1467839928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TIFFANY MOORE

Provider Business Mailing Address
First Line	:	8400 WEST CHALESTON BLVD APT 208
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117
Country	:	US
Telephone Number	:	702-624-7796
Fax Number	:

Provider Business Practice Location Address
First Line	:	8400 W CHARLESTON BLVD APT 208
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-9034
Country	:	US
Telephone Number	:	702-624-7796
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2015
Last Update Date	:	05/04/2015

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Directions to “ MS. TIFFANY MOORE ” Practice Location

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