Provider Demographics
NPI:1912627639
Name:DEAN, TYFANI LYNN (CERTIFIED NURSE AID)
Entity Type:Individual
Prefix:
First Name:TYFANI
Middle Name:LYNN
Last Name:DEAN
Suffix:
Gender:F
Credentials:CERTIFIED NURSE AID
Other - Prefix:
Other - First Name:TYFANI
Other - Middle Name:LYNN
Other - Last Name:HAMMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:305 NE HAYES ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:50849-1218
Mailing Address - Country:US
Mailing Address - Phone:904-303-7110
Mailing Address - Fax:
Practice Address - Street 1:326 SUMMERSET ST
Practice Address - Street 2:
Practice Address - City:FONTANELLE
Practice Address - State:IA
Practice Address - Zip Code:50846-8098
Practice Address - Country:US
Practice Address - Phone:641-745-4191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide