Provider Demographics
NPI:1518463785
Name:WILLIAMS, TIFFANIE
Entity Type:Individual
Prefix:
First Name:TIFFANIE
Middle Name:
Last Name:WILLIAMS
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:PO BOX 120264
Mailing Address - Street 2:
Mailing Address - City:W MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32912-0264
Mailing Address - Country:US
Mailing Address - Phone:716-491-9433
Mailing Address - Fax:
Practice Address - Street 1:1344 MIT CT NW
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907
Practice Address - Country:US
Practice Address - Phone:321-210-9903
Practice Address - Fax:877-617-8004
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-05
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities