Provider Demographics
NPI:1396478061
Name:RUSSELL, TIERRA NECOLE (CPPD)
Entity type:Individual
Prefix:MRS
First Name:TIERRA
Middle Name:NECOLE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:CPPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 W TIFFANY DR APT 3
Mailing Address - Street 2:
Mailing Address - City:MANGONIA PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33407-3252
Mailing Address - Country:US
Mailing Address - Phone:561-335-0028
Mailing Address - Fax:
Practice Address - Street 1:812 W TIFFANY DR APT 3
Practice Address - Street 2:
Practice Address - City:MANGONIA PARK
Practice Address - State:FL
Practice Address - Zip Code:33407-3252
Practice Address - Country:US
Practice Address - Phone:561-335-0028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula