Provider Demographics
NPI:1629330899
Name:WELLS, TIFFANY RENEE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:RENEE
Last Name:WELLS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2421 ANTON ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36612-2103
Mailing Address - Country:US
Mailing Address - Phone:251-786-6510
Mailing Address - Fax:251-285-6083
Practice Address - Street 1:2421 ANTON ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36612-2103
Practice Address - Country:US
Practice Address - Phone:251-786-6510
Practice Address - Fax:251-285-6083
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2-056571164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse