Provider Demographics
NPI:1962127928
Name:BROUGHTON, TIFFANY MAE
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:MAE
Last Name:BROUGHTON
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 1:85 TOWNSHIP ROAD 340
Mailing Address - Street 2:
Mailing Address - City:PROCTORVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45669-9089
Mailing Address - Country:US
Mailing Address - Phone:606-225-5104
Mailing Address - Fax:
Practice Address - Street 1:609 3RD AVE
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:OH
Practice Address - Zip Code:45619-1038
Practice Address - Country:US
Practice Address - Phone:740-451-5780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator