Provider Demographics
NPI:1659191716
Name:VARGAS, TIFFANY L (CPSP)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:L
Last Name:VARGAS
Suffix:
Gender:F
Credentials:CPSP
Other - Prefix:MS
Other - First Name:TIFFANY
Other - Middle Name:L
Other - Last Name:KEPPEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:210 RAINBOW DR LOT 20
Mailing Address - Street 2:
Mailing Address - City:BURNS HARBOR
Mailing Address - State:IN
Mailing Address - Zip Code:46304-9790
Mailing Address - Country:US
Mailing Address - Phone:219-406-6869
Mailing Address - Fax:
Practice Address - Street 1:210 RAINBOW DR LOT 20
Practice Address - Street 2:
Practice Address - City:BURNS HARBOR
Practice Address - State:IN
Practice Address - Zip Code:46304-9790
Practice Address - Country:US
Practice Address - Phone:219-406-6869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist