Provider Demographics
NPI:1093468175
Name:MILLER, TIFFANY L (CPT)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5747 KINGFISH DR APT C
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-5946
Mailing Address - Country:US
Mailing Address - Phone:352-408-5066
Mailing Address - Fax:
Practice Address - Street 1:5747 KINGFISH DR APT C
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-5946
Practice Address - Country:US
Practice Address - Phone:352-408-5066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-30
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22-0109246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty