Provider Demographics
NPI:1245509538
Name:MAZZOLI, TIFFANY ANNE
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:ANNE
Last Name:MAZZOLI
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 1:100 E MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:WAVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39576-3238
Mailing Address - Country:US
Mailing Address - Phone:228-342-7892
Mailing Address - Fax:
Practice Address - Street 1:100 E MEADOW LN
Practice Address - Street 2:
Practice Address - City:WAVELAND
Practice Address - State:MS
Practice Address - Zip Code:39576-3238
Practice Address - Country:US
Practice Address - Phone:228-342-7892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care