MEDICARE: TIFFANY LANE BRAGG

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	246Z00000X	Other Specialist/Technologist		IN

General Provider Information

NPI Number	:	1841142239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY LANE BRAGG

Provider Business Mailing Address
First Line	:	1125 N WESTERN AVE
Second Line	:
City	:	MARION
State	:	IN
Zip	:	46952-2501
Country	:	US
Telephone Number	:	765-661-0353
Fax Number	:

Provider Business Practice Location Address
First Line	:	1125 N WESTERN AVE
Second Line	:
City	:	MARION
State	:	IN
Zip	:	46952-2501
Country	:	US
Telephone Number	:	765-661-0353
Fax Number	:

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

Provider Enumeration Date	:	02/10/2026
Last Update Date	:	02/10/2026

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Directions to “ TIFFANY LANE BRAGG ” Practice Location

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