Provider Demographics
NPI:1255025011
Name:MINTON, TIFFANY CARLY
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:CARLY
Last Name:MINTON
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 1:734 N SE BOUTELL RD
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-9199
Mailing Address - Country:US
Mailing Address - Phone:989-450-6471
Mailing Address - Fax:
Practice Address - Street 1:734 N SE BOUTELL RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-9199
Practice Address - Country:US
Practice Address - Phone:989-450-6471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program