Provider Demographics
NPI:1952432858
Name:JAMERSON, TIFFANY (CFM, CFTS)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:JAMERSON
Suffix:
Gender:F
Credentials:CFM, CFTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 BALLARD DR
Mailing Address - Street 2:
Mailing Address - City:CASTLE HAYNE
Mailing Address - State:NC
Mailing Address - Zip Code:28429-5600
Mailing Address - Country:US
Mailing Address - Phone:910-350-0067
Mailing Address - Fax:
Practice Address - Street 1:1142 SHIPYARD BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-6439
Practice Address - Country:US
Practice Address - Phone:910-350-0067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795101Medicaid