Provider Demographics
NPI:1447746250
Name:STARKEY, TIFFANI BRIANA
Entity Type:Individual
Prefix:
First Name:TIFFANI
Middle Name:BRIANA
Last Name:STARKEY
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 1:2637 NW 9TH ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33993-5717
Mailing Address - Country:US
Mailing Address - Phone:302-670-6753
Mailing Address - Fax:239-599-8602
Practice Address - Street 1:1490 NE PINE ISLAND RD STE 7F
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-2128
Practice Address - Country:US
Practice Address - Phone:239-599-8733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-04
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-19-35305103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100513300Medicaid