Provider Demographics
NPI:1235194622
Name:HILLIGOSS, TIFFANY KAROLINE (RD LD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:KAROLINE
Last Name:HILLIGOSS
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:K
Other - Last Name:HOLMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1900 CENTRACARE CIR
Mailing Address - Street 2:SUITE 2400
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-5000
Mailing Address - Country:US
Mailing Address - Phone:320-229-4916
Mailing Address - Fax:320-240-2100
Practice Address - Street 1:1900 CENTRACARE CIR
Practice Address - Street 2:SUITE 2400
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-229-4916
Practice Address - Fax:320-240-2100
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3563133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK04835Medicare ID - Type Unspecified