Provider Demographics
NPI:1902146525
Name:WEST, TIFFANY N (RT (S) (ARRT))
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:N
Last Name:WEST
Suffix:
Gender:F
Credentials:RT (S) (ARRT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 BOWMAN LN
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-3183
Mailing Address - Country:US
Mailing Address - Phone:850-747-8822
Mailing Address - Fax:850-747-8664
Practice Address - Street 1:511 E 23RD ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-5307
Practice Address - Country:US
Practice Address - Phone:850-747-8822
Practice Address - Fax:850-747-8664
Is Sole Proprietor?:No
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5089172471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography