Provider Demographics
NPI:1396491635
Name:TYREE, TIFFANY JEAN
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:JEAN
Last Name:TYREE
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 1:4702 LEONARD BLVD S
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33973-6157
Mailing Address - Country:US
Mailing Address - Phone:239-219-4254
Mailing Address - Fax:
Practice Address - Street 1:4702 LEONARD BLVD S
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33973-6157
Practice Address - Country:US
Practice Address - Phone:239-219-4254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22000078219372600000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No372600000XNursing Service Related ProvidersAdult Companion