MEDICARE: TIFFANY CAMMON

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	3747P1801X	Personal Care Attendant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2104419737	OTHER	NV	AGENCY

General Provider Information

NPI Number	:	1902386501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY CAMMON

Provider Business Mailing Address
First Line	:	6166 S SANDHILL RD STE 130
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3221
Country	:	US
Telephone Number	:	702-629-8226
Fax Number	:

Provider Business Practice Location Address
First Line	:	6166 S SANDHILL RD STE 130
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3221
Country	:	US
Telephone Number	:	702-629-8226
Fax Number	:

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

Provider Enumeration Date	:	08/14/2018
Last Update Date	:	08/14/2018

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Directions to “ TIFFANY CAMMON ” Practice Location

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