Provider Demographics
NPI:1164856837
Name:GODWIN, TIFFANY C
Entity Type:Individual
Prefix:MISS
First Name:TIFFANY
Middle Name:C
Last Name:GODWIN
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:PO BOX 353
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT JOE
Mailing Address - State:FL
Mailing Address - Zip Code:32457-0353
Mailing Address - Country:US
Mailing Address - Phone:850-991-0199
Mailing Address - Fax:
Practice Address - Street 1:116 NORTH 36TH STREET
Practice Address - Street 2:
Practice Address - City:MEXICO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32410-0353
Practice Address - Country:US
Practice Address - Phone:850-991-0199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker