Provider Demographics
NPI:1811577505
Name:FORBES, TIFFANY N
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:N
Last Name:FORBES
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:PO BOX 26987
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33320-6987
Mailing Address - Country:US
Mailing Address - Phone:954-770-7644
Mailing Address - Fax:
Practice Address - Street 1:6100 LAKE ELLENOR DR STE 151
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-4632
Practice Address - Country:US
Practice Address - Phone:407-552-5444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty