Provider Demographics
NPI:1881866366
Name:SAMUELS, TIFFANY MONIQUE (EMT-B/ HEALTHCARE SP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:MONIQUE
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:EMT-B/ HEALTHCARE SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 ANDREWS AVENUE
Mailing Address - Street 2:LYSTER ARMY HEALTH CLINIC
Mailing Address - City:FORT RUCKER
Mailing Address - State:AL
Mailing Address - Zip Code:36362
Mailing Address - Country:US
Mailing Address - Phone:334-255-7894
Mailing Address - Fax:334-255-7490
Practice Address - Street 1:301 ANDREWS AVENUE
Practice Address - Street 2:LYSTER ARMY HEALTH CLINIC
Practice Address - City:FORT RUCKER
Practice Address - State:AL
Practice Address - Zip Code:36362
Practice Address - Country:US
Practice Address - Phone:334-255-7894
Practice Address - Fax:334-255-7490
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No376K00000XNursing Service Related ProvidersNurse's Aide