Provider Demographics
NPI:1073214979
Name:DAVIS, TIFFANIE LATRICE
Entity Type:Individual
Prefix:MS
First Name:TIFFANIE
Middle Name:LATRICE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5910 GERTRUDE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-3506
Mailing Address - Country:US
Mailing Address - Phone:440-705-0023
Mailing Address - Fax:
Practice Address - Street 1:5910 GERTRUDE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-3506
Practice Address - Country:US
Practice Address - Phone:440-705-0023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRT687481347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle