Provider Demographics
NPI:1811338304
Name:RAND, TIFFANY RACQUEL
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:RACQUEL
Last Name:RAND
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 1:2560 PREVIS RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-2775
Mailing Address - Country:US
Mailing Address - Phone:786-503-4449
Mailing Address - Fax:
Practice Address - Street 1:2560 PREVIS RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-2775
Practice Address - Country:US
Practice Address - Phone:786-503-4449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management