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Individual

TIFANY BREVALDO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPN

Contact information

Practice address
4014 S 270TH ST, KENT, WA 98032-7139
(253) 945-4000
Mailing address
1812 S L ST, TACOMA, WA 98405-3962
(904) 814-3499

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
5252259
FL

Other

Enumeration date
09/27/2023
Last updated
09/27/2023
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