Provider Demographics
NPI:1932639325
Name:STREETMAN, TIFFANI LYNN (ATC)
Entity Type:Individual
Prefix:
First Name:TIFFANI
Middle Name:LYNN
Last Name:STREETMAN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:TIFFANI
Other - Middle Name:LYNN
Other - Last Name:MEREDITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:701 WELLINGTON HILLS RD APT 217
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-2174
Mailing Address - Country:US
Mailing Address - Phone:501-282-7256
Mailing Address - Fax:
Practice Address - Street 1:300 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-4003
Practice Address - Country:US
Practice Address - Phone:800-264-5384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2017-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer