Provider Demographics
NPI:1619364916
Name:MOORE, TIFFANY DY
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:DY
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:TIFFANY
Other - Middle Name:ESCALANTE
Other - Last Name:DY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:625 19TH ST S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35249
Mailing Address - Country:US
Mailing Address - Phone:205-217-1721
Mailing Address - Fax:
Practice Address - Street 1:625 19TH ST S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35249
Practice Address - Country:US
Practice Address - Phone:205-638-9589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-24
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program