Provider Demographics
NPI:1518340355
Name:DAVIS, TIFFANY (RD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 E VENICE AVE
Mailing Address - Street 2:STE 205
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-9082
Mailing Address - Country:US
Mailing Address - Phone:941-800-4700
Mailing Address - Fax:941-800-4711
Practice Address - Street 1:1370 E VENICE AVE
Practice Address - Street 2:STE 205
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-9082
Practice Address - Country:US
Practice Address - Phone:941-800-4700
Practice Address - Fax:941-800-4711
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND6940133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered