Provider Demographics
NPI:1073274247
Name:GARRETT, TIFFANY DIANNA
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:DIANNA
Last Name:GARRETT
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 1:2208 KIRBY RD TRLR 185B
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WV
Mailing Address - Zip Code:25541-1095
Mailing Address - Country:US
Mailing Address - Phone:304-939-1090
Mailing Address - Fax:
Practice Address - Street 1:2208 KIRBY RD TRLR 185B
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WV
Practice Address - Zip Code:25541-1095
Practice Address - Country:US
Practice Address - Phone:304-939-1090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant