Provider Demographics
NPI:1710715875
Name:LOTT, TIFFANY (RN)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:
Last Name:LOTT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1738 JUPITER RD
Mailing Address - Street 2:
Mailing Address - City:MENDENHALL
Mailing Address - State:MS
Mailing Address - Zip Code:39114-4364
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5096 US 49
Practice Address - Street 2:
Practice Address - City:PINEY WOODS
Practice Address - State:MS
Practice Address - Zip Code:39148
Practice Address - Country:US
Practice Address - Phone:601-845-2214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS913372163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool