Provider Demographics
NPI:1942464193
Name:MONROE, TIFFANY D
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:D
Last Name:MONROE
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 1:8512 SILVER RD
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102-8260
Mailing Address - Country:US
Mailing Address - Phone:803-696-6212
Mailing Address - Fax:
Practice Address - Street 1:188 S PIKE E STE 1C
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-2131
Practice Address - Country:US
Practice Address - Phone:803-848-4015
Practice Address - Fax:803-848-4015
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide