Provider Demographics
NPI:1700774478
Name:HARRIS, TIFFANY JAMELA
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:JAMELA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:JAMELA
Other - Last Name:FULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:2583 LAND RUSH DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-9371
Mailing Address - Country:US
Mailing Address - Phone:216-571-8207
Mailing Address - Fax:
Practice Address - Street 1:2583 LAND RUSH DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89002-9371
Practice Address - Country:US
Practice Address - Phone:216-571-8207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV869469164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse