Individual
TIFFANY MCKENNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11039 COLONIAL TAVERN LN, JACKSONVILLE, FL 32221-2123
(904) 450-1430
Mailing address
11039 COLONIAL TAVERN LN, JACKSONVILLE, FL 32221-2123
(904) 450-1430
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
291U00000X
Clinical Medical Laboratory
10D2254281
FL
374U00000X
Home Health Aide
Primary
—
FL
376J00000X
Homemaker
—
—
376K00000X
Nurse's Aide
—
—
Other
Enumeration date
06/29/2017
Last updated
03/28/2022
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