Provider Demographics
NPI:1881217867
Name:MAULTSBY, TIFFANY N (RN)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:N
Last Name:MAULTSBY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 BRISTOL DR
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32922-7304
Mailing Address - Country:US
Mailing Address - Phone:321-313-7707
Mailing Address - Fax:321-208-8809
Practice Address - Street 1:3890 OAKLAND ST
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32927-8417
Practice Address - Country:US
Practice Address - Phone:321-313-7707
Practice Address - Fax:321-208-8809
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-25
Last Update Date:2020-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9484252163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse