Provider Demographics
NPI:1679022461
Name:DAILY, TIFFANY
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:DAILY
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 1:300 MADDEN AVE.
Mailing Address - Street 2:
Mailing Address - City:BRAGGS
Mailing Address - State:OK
Mailing Address - Zip Code:74423
Mailing Address - Country:US
Mailing Address - Phone:918-487-5265
Mailing Address - Fax:918-487-2012
Practice Address - Street 1:300 MADDEN AVE.
Practice Address - Street 2:
Practice Address - City:BRAGGS
Practice Address - State:OK
Practice Address - Zip Code:74423
Practice Address - Country:US
Practice Address - Phone:918-487-5265
Practice Address - Fax:918-487-2012
Is Sole Proprietor?:No
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant