Provider Demographics
NPI:1366850323
Name:HAYES, TIFFANY JONES
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:JONES
Last Name:HAYES
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 1:9602 SEAVIEW DR
Mailing Address - Street 2:APT 104
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-7698
Mailing Address - Country:US
Mailing Address - Phone:352-434-9704
Mailing Address - Fax:352-787-8994
Practice Address - Street 1:9602 SEAVIEW DR
Practice Address - Street 2:APT 104
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-7698
Practice Address - Country:US
Practice Address - Phone:352-434-9704
Practice Address - Fax:352-787-8994
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL003176500385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child