Provider Demographics
NPI:1710567367
Name:BENNETT, TIFFANY L (CNA, CCMA)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:L
Last Name:BENNETT
Suffix:
Gender:F
Credentials:CNA, CCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2065 N HIGHLAND AVE APT 133F
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33755-1326
Mailing Address - Country:US
Mailing Address - Phone:727-288-5454
Mailing Address - Fax:
Practice Address - Street 1:2065 N HIGHLAND AVE APT 133F
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33755-1326
Practice Address - Country:US
Practice Address - Phone:727-288-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL237463372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL279858OtherCNA