Provider Demographics
NPI:1245747625
Name:WHITT, TIFFANY LOURDES
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LOURDES
Last Name:WHITT
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 1:165 ROCK LANE DR
Mailing Address - Street 2:
Mailing Address - City:DOBSON
Mailing Address - State:NC
Mailing Address - Zip Code:27017-8205
Mailing Address - Country:US
Mailing Address - Phone:336-429-0933
Mailing Address - Fax:
Practice Address - Street 1:165 ROCK LANE DR
Practice Address - Street 2:
Practice Address - City:DOBSON
Practice Address - State:NC
Practice Address - Zip Code:27017-8205
Practice Address - Country:US
Practice Address - Phone:336-429-0933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-06
Last Update Date:2018-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program