Provider Demographics
NPI:1720334071
Name:TYSON, TIFFINEY
Entity Type:Individual
Prefix:MS
First Name:TIFFINEY
Middle Name:
Last Name:TYSON
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 1:5200 NORWOOD AVE
Mailing Address - Street 2:SUITE 23
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-5029
Mailing Address - Country:US
Mailing Address - Phone:904-379-1392
Mailing Address - Fax:
Practice Address - Street 1:5200 NORWOOD AVE
Practice Address - Street 2:SUITE 23
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-5029
Practice Address - Country:US
Practice Address - Phone:904-379-1392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator