Provider Demographics
NPI:1295367167
Name:HINDS, TIFFANY
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:HINDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:SHERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COSMETOLOGIST
Mailing Address - Street 1:766 STONECREST DR
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:MI
Mailing Address - Zip Code:49345-9525
Mailing Address - Country:US
Mailing Address - Phone:616-325-0902
Mailing Address - Fax:
Practice Address - Street 1:766 STONECREST DR
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:MI
Practice Address - Zip Code:49345-9525
Practice Address - Country:US
Practice Address - Phone:616-325-0902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide