Provider Demographics
NPI:1093085979
Name:DURAN, TIFFANY ELIZABETH (MS, ATC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ELIZABETH
Last Name:DURAN
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 CABIN DR
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-7876
Mailing Address - Country:US
Mailing Address - Phone:806-789-9718
Mailing Address - Fax:
Practice Address - Street 1:300 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-4427
Practice Address - Country:US
Practice Address - Phone:803-536-8625
Practice Address - Fax:803-533-3801
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT43832255A2300X
SC13062255A2300X
TX20000058502255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer