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Individual

TIFFANY D GREEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
717 WOODLAND AVE, QUINCY, FL 32351-1312
(850) 354-3530
Mailing address
717 WOODLAND AVE, QUINCY, FL 32351-1312
(850) 354-3530

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN5163698
FL
172V00000X
Community Health Worker
253Z00000X
In Home Supportive Care Agency

Other

Enumeration date
08/02/2018
Last updated
08/02/2018
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