Individual
TIFFANY C PROVOST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13691 S BROWN FARM LN, DRAPER, UT 84020-7809
(801) 987-0788
Mailing address
7853 N OAKWOOD DR, EAGLE MOUNTAIN, UT 84005-7212
(435) 503-7707
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
10/24/2023
Last updated
10/24/2023
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