Basic Information
| Provider Information | |||||||||
| NPI: | 1346865169 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRAUER | ||||||||
| FirstName: | TIFFANY | ||||||||
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| Credential: | RD, LD/N | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1105 SUTHERLAND PLZ | ||||||||
| Address2: | |||||||||
| City: | LYNN HAVEN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324448331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8505275194 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3212 JENKS AVE | ||||||||
| Address2: | |||||||||
| City: | PANAMA CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324054224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8507711521 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2020 | ||||||||
| LastUpdateDate: | 06/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | ND8776 | FL | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.