Provider Demographics
NPI:1760252324
Name:WILLIAMS, TIFFANY EPRELL
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:EPRELL
Last Name:WILLIAMS
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 1:9050 NW 40TH PL
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-8847
Mailing Address - Country:US
Mailing Address - Phone:754-801-6583
Mailing Address - Fax:
Practice Address - Street 1:9050 NW 40TH PL
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-8847
Practice Address - Country:US
Practice Address - Phone:754-801-6583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty