Provider Demographics
NPI:1366972648
Name:VASEK, TIFFANY CAMILLE
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:CAMILLE
Last Name:VASEK
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 1:3045 RANCHETTE SQ
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-2611
Mailing Address - Country:US
Mailing Address - Phone:850-502-1548
Mailing Address - Fax:
Practice Address - Street 1:2114 AIRPORT BLVD FL
Practice Address - Street 2:SUITE 1150/1250
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504
Practice Address - Country:US
Practice Address - Phone:850-400-8433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-19
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15017101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health