Provider Demographics
NPI:1205187929
Name:CROWDER, TIFFANY LEWIS
Entity Type:Individual
Prefix:MISS
First Name:TIFFANY
Middle Name:LEWIS
Last Name:CROWDER
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 1:260 CHRISTIANA RD APT K12
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-2954
Mailing Address - Country:US
Mailing Address - Phone:302-505-4000
Mailing Address - Fax:
Practice Address - Street 1:260 CHRISTIANA RD APT K12
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-2954
Practice Address - Country:US
Practice Address - Phone:302-505-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
E3479026146N00000X
MD2056071146N00000X
DE640464146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic