Provider Demographics
NPI:1851967145
Name:BROOKS, TIFFANI BRIANA
Entity Type:Individual
Prefix:
First Name:TIFFANI
Middle Name:BRIANA
Last Name:BROOKS
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 1:356 NW 11TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BELLE GLADE
Mailing Address - State:FL
Mailing Address - Zip Code:33430-2963
Mailing Address - Country:US
Mailing Address - Phone:561-985-8433
Mailing Address - Fax:
Practice Address - Street 1:3060 MELALEUCA LN
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-5174
Practice Address - Country:US
Practice Address - Phone:561-357-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9562858163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse