Provider Demographics
NPI:1003007055
Name:HOWARD, TIFFANY NICOLE (MD)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:NICOLE
Last Name:HOWARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:103 SUM MOR DR
Mailing Address - Street 2:VITALITY MEDICAL CENTERS, INC.
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-4828
Mailing Address - Country:US
Mailing Address - Phone:803-218-9886
Mailing Address - Fax:
Practice Address - Street 1:103 SUM MOR DR
Practice Address - Street 2:VITALITY MEDICAL CENTERS, INC.
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4828
Practice Address - Country:US
Practice Address - Phone:803-218-9886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101241315208100000X
SC36775208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation