Provider Demographics
NPI:1346865169
Name:BRAUER, TIFFANY (RD, LD/N)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:BRAUER
Suffix:
Gender:F
Credentials:RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 SUTHERLAND PLZ
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-8331
Mailing Address - Country:US
Mailing Address - Phone:850-527-5194
Mailing Address - Fax:
Practice Address - Street 1:3212 JENKS AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4224
Practice Address - Country:US
Practice Address - Phone:850-771-1521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND8776133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered