Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0004X | Health Psychologist | P1800012904 | FL |
NPI | 1427545953 |
---|---|
Provider Name | Tiffani Betancourt |
First Address | Tampa, FL 33604-1643 |
Second Address | Tampa, FL 33604-1643 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2018 |
Last Update Date | 19/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
824387070 | GUARDIAN ACCOUNTING GROUP LLC (01) | FL |