Provider Demographics
NPI:1649749862
Name:ROBERTS, TIFFANY BROOKE
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:BROOKE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TIFFANY
Other - Middle Name:BROOKE
Other - Last Name:PITTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13942 SW 43RD ST
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-5735
Mailing Address - Country:US
Mailing Address - Phone:954-257-8594
Mailing Address - Fax:
Practice Address - Street 1:13942 SW 43RD ST
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-5735
Practice Address - Country:US
Practice Address - Phone:954-257-8594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI32112355S0801X
FL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant