Provider Demographics
NPI:1265723324
Name:MILLER, TIFFANY AMANDA-LEE (BS)
Entity type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:AMANDA-LEE
Last Name:MILLER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4425 S. JONES
Mailing Address - Street 2:SUITE D3
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103
Mailing Address - Country:US
Mailing Address - Phone:702-991-3150
Mailing Address - Fax:866-658-4052
Practice Address - Street 1:4425 S JONES BLVD
Practice Address - Street 2:SUITE D3
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-3370
Practice Address - Country:US
Practice Address - Phone:702-991-3150
Practice Address - Fax:866-658-4052
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1023324076Medicaid