Provider Demographics
NPI:1265134118
Name:BIVENS, TIFFANY MONIQUE
Entity type:Individual
Prefix:MISS
First Name:TIFFANY
Middle Name:MONIQUE
Last Name:BIVENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3252 CESERY BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-3116
Mailing Address - Country:US
Mailing Address - Phone:352-619-6299
Mailing Address - Fax:352-260-0894
Practice Address - Street 1:3252 CESERY BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-3116
Practice Address - Country:US
Practice Address - Phone:352-619-6299
Practice Address - Fax:325-260-0894
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-21
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL376J00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No251E00000XAgenciesHome Health