Provider Demographics
NPI:1982293395
Name:DEBRUCE, TIFFANY CHERRELLE
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:CHERRELLE
Last Name:DEBRUCE
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 1:874 N HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44310-2028
Mailing Address - Country:US
Mailing Address - Phone:330-310-8086
Mailing Address - Fax:
Practice Address - Street 1:874 N HOWARD ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-2028
Practice Address - Country:US
Practice Address - Phone:330-310-8086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide