Provider Demographics
NPI:1407103955
Name:COURSEY, TIFFANY EVERLINE
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:EVERLINE
Last Name:COURSEY
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 1:3580 FOREST HAVEN LN STE G
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5134
Mailing Address - Country:US
Mailing Address - Phone:757-484-7111
Mailing Address - Fax:757-484-7118
Practice Address - Street 1:3580 FOREST HAVEN LN STE G
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5134
Practice Address - Country:US
Practice Address - Phone:757-484-7111
Practice Address - Fax:757-484-7118
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101001935237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist