Provider Demographics
NPI:1508452954
Name:SCOVILLE, TIFFINI
Entity Type:Individual
Prefix:MRS
First Name:TIFFINI
Middle Name:
Last Name:SCOVILLE
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 1:2058 ALTA MEADOWS LN APT 2509
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444-1189
Mailing Address - Country:US
Mailing Address - Phone:813-965-2663
Mailing Address - Fax:
Practice Address - Street 1:2058 ALTA MEADOWS LN APT 2509
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444-1189
Practice Address - Country:US
Practice Address - Phone:813-965-2663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9521620163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-SurgicalGroup - Single Specialty