Provider Demographics
NPI:1184023798
Name:CARROTHERS, TIFFANY (RT(N))
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:CARROTHERS
Suffix:
Gender:F
Credentials:RT(N)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 BICENTENNIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89044-0519
Mailing Address - Country:US
Mailing Address - Phone:773-419-0068
Mailing Address - Fax:
Practice Address - Street 1:3000 BICENTENNIAL PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89044-0519
Practice Address - Country:US
Practice Address - Phone:773-419-0068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide