Provider Demographics
NPI:1225862170
Name:MATTHEWS, TIFFANY RENA
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:RENA
Last Name:MATTHEWS
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 1:605 M C MOORE RD
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-2074
Mailing Address - Country:US
Mailing Address - Phone:985-981-4398
Mailing Address - Fax:
Practice Address - Street 1:605 M C MOORE RD
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-2074
Practice Address - Country:US
Practice Address - Phone:985-981-4398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-31
Last Update Date:2024-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)