Provider Demographics
NPI:1679227052
Name:WARE, TIFFANY LASHAY
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LASHAY
Last Name:WARE
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 1:888 CARMILLION CT
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:FL
Mailing Address - Zip Code:34736-3680
Mailing Address - Country:US
Mailing Address - Phone:407-276-4357
Mailing Address - Fax:
Practice Address - Street 1:888 CARMILLION CT
Practice Address - Street 2:
Practice Address - City:GROVELAND
Practice Address - State:FL
Practice Address - Zip Code:34736-3680
Practice Address - Country:US
Practice Address - Phone:407-276-4357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QD1600X261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities