Provider Demographics
NPI:1598493702
Name:WINDER, TIFANY YVETTE
Entity Type:Individual
Prefix:
First Name:TIFANY
Middle Name:YVETTE
Last Name:WINDER
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 1:660 BELL RD APT 619
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-5006
Mailing Address - Country:US
Mailing Address - Phone:901-230-1862
Mailing Address - Fax:
Practice Address - Street 1:5511 EDMONDSON PIKE APT 619
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-5870
Practice Address - Country:US
Practice Address - Phone:615-564-4984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNW192643363OtherAETNA