Provider Demographics
NPI:1831966704
Name:WEBB, TIFFANY (CARETAKER)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:WEBB
Suffix:
Gender:F
Credentials:CARETAKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185 LAPORT AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT MORRIS
Mailing Address - State:MI
Mailing Address - Zip Code:48458-2574
Mailing Address - Country:US
Mailing Address - Phone:810-627-9392
Mailing Address - Fax:
Practice Address - Street 1:1185 LAPORT AVE
Practice Address - Street 2:
Practice Address - City:MOUNT MORRIS
Practice Address - State:MI
Practice Address - Zip Code:48458-2574
Practice Address - Country:US
Practice Address - Phone:810-627-9392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health