Provider Demographics
NPI:1487424453
Name:JACOBS-MILLETT, TIFFANY LAURA (RD,LD,CLC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LAURA
Last Name:JACOBS-MILLETT
Suffix:
Gender:F
Credentials:RD,LD,CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 TABER HILL RD
Mailing Address - Street 2:
Mailing Address - City:VASSALBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04989-3035
Mailing Address - Country:US
Mailing Address - Phone:207-538-8125
Mailing Address - Fax:
Practice Address - Street 1:99 TABER HILL RD
Practice Address - Street 2:
Practice Address - City:VASSALBORO
Practice Address - State:ME
Practice Address - Zip Code:04989-3035
Practice Address - Country:US
Practice Address - Phone:207-538-8125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDI1739133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty