Provider Demographics
NPI:1255166518
Name:GUTIERREZ, TIFFANY C (HIS)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:C
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-2434
Mailing Address - Country:US
Mailing Address - Phone:352-799-3221
Mailing Address - Fax:
Practice Address - Street 1:1126 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-2434
Practice Address - Country:US
Practice Address - Phone:352-799-3221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS5762237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist