Provider Demographics
NPI:1851063200
Name:DUBLIN, TIFFANY FAYE
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:FAYE
Last Name:DUBLIN
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 1:16 ROCKWOOD PL NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1728
Mailing Address - Country:US
Mailing Address - Phone:408-837-0116
Mailing Address - Fax:
Practice Address - Street 1:16 ROCKWOOD PL NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1728
Practice Address - Country:US
Practice Address - Phone:706-528-8681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0009090125376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty