Provider Demographics
NPI:1578005104
Name:STAMPS, TIFFANY BROOKE (RN)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:BROOKE
Last Name:STAMPS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5209 GLENMOUNT ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-3614
Mailing Address - Country:US
Mailing Address - Phone:803-422-1491
Mailing Address - Fax:
Practice Address - Street 1:5209 GLENMOUNT ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-3614
Practice Address - Country:US
Practice Address - Phone:803-422-1491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC98117163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse