Provider Demographics
NPI:1184466781
Name:HERRERA, TIFFANY M
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:M
Last Name:HERRERA
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 1:1801 BRANTLEY RD APT 902
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3967
Mailing Address - Country:US
Mailing Address - Phone:239-839-3024
Mailing Address - Fax:
Practice Address - Street 1:1801 BRANTLEY RD APT 902
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3967
Practice Address - Country:US
Practice Address - Phone:239-839-3024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25320225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist