Provider Demographics
NPI:1588921811
Name:CUE, TIFFANY DANIELLE (CNA)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:DANIELLE
Last Name:CUE
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3532 ASH ST
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-1875
Mailing Address - Country:US
Mailing Address - Phone:951-760-0537
Mailing Address - Fax:
Practice Address - Street 1:3532 ASH ST
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-1875
Practice Address - Country:US
Practice Address - Phone:951-760-0537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00796060376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide