Provider Demographics
NPI:1447965389
Name:GILES, TIFFANY R
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:R
Last Name:GILES
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 1:200 GRAND AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PRUDENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48651-9571
Mailing Address - Country:US
Mailing Address - Phone:989-366-9166
Mailing Address - Fax:
Practice Address - Street 1:200 GRAND AVE
Practice Address - Street 2:
Practice Address - City:PRUDENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48651-9571
Practice Address - Country:US
Practice Address - Phone:893-669-1669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker