Provider Demographics
NPI:1821479437
Name:BROWN, TIFFANY DONNETTE (HAIR LOSS SPECIALIST)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:DONNETTE
Last Name:BROWN
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 QUARTERMASTER RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-1311
Mailing Address - Country:US
Mailing Address - Phone:864-308-9891
Mailing Address - Fax:
Practice Address - Street 1:2084 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1425
Practice Address - Country:US
Practice Address - Phone:864-308-9891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCNO NUMBER1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management