Provider Demographics
NPI:1588496129
Name:SMITH, TIFFANY K
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:K
Last Name:SMITH
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:KADENA DISEASE MANAGEMENT
Mailing Address - Street 2:18TH MDG UNIT 5267 KADENA AB, JAPAN
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96368
Mailing Address - Country:US
Mailing Address - Phone:409-553-1015
Mailing Address - Fax:
Practice Address - Street 1:KADENA DISEASE MANAGEMENT
Practice Address - Street 2:18TH MDG UNIT 5267 KADENA AB, JAPAN
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96368
Practice Address - Country:US
Practice Address - Phone:409-553-1015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE72558163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator