Provider Demographics
NPI:1235456112
Name:GILLIS, TIFFANY L (AP)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:L
Last Name:GILLIS
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5220 S UNIVERSITY DR STE 209
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-5318
Mailing Address - Country:US
Mailing Address - Phone:954-579-4936
Mailing Address - Fax:954-894-1166
Practice Address - Street 1:4900 S UNIVERSITY DR
Practice Address - Street 2:SUITE 110
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-3808
Practice Address - Country:US
Practice Address - Phone:954-579-4936
Practice Address - Fax:954-894-1166
Is Sole Proprietor?:No
Enumeration Date:2010-04-30
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2655171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist