Individual
TIFFANY LA'TRELLE NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2486 QUACCO RD, POOLER, GA 31322-8402
(912) 272-5834
Mailing address
PO BOX 18416, GARDEN CITY, GA 31418-0416
(912) 272-5834
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
Other
Enumeration date
10/31/2017
Last updated
10/31/2017
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