Provider Demographics
NPI:1639895733
Name:COTTEN, TIFFANY MERRITT (MBA)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:MERRITT
Last Name:COTTEN
Suffix:
Gender:F
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6714 MORGANTOWN ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-6643
Mailing Address - Country:US
Mailing Address - Phone:919-627-2636
Mailing Address - Fax:
Practice Address - Street 1:1631 MIDTOWN PL STE 104-126
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-1300
Practice Address - Country:US
Practice Address - Phone:919-627-2636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health