Provider Demographics
NPI:1841070984
Name:HUDDLESTON, TIFFANY LORAIN
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LORAIN
Last Name:HUDDLESTON
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 1:2652 POWDER DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-5701
Mailing Address - Country:US
Mailing Address - Phone:775-444-8235
Mailing Address - Fax:
Practice Address - Street 1:2652 POWDER DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-5701
Practice Address - Country:US
Practice Address - Phone:775-444-8235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide