Provider Demographics
NPI:1093503898
Name:BRINTLEY, TIFFANY CHANTELL
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:CHANTELL
Last Name:BRINTLEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22430 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089-2746
Mailing Address - Country:US
Mailing Address - Phone:248-897-6661
Mailing Address - Fax:
Practice Address - Street 1:22430 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-2746
Practice Address - Country:US
Practice Address - Phone:248-897-6661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI000031602376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide