Tiki Stafford

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL11951 Issued in FL

Legal business name

TIKI STAFFORD

Practice address

3225 N Myrtle Ave
Jacksonville, FL 32209-4231

Phone

(904) 233-1090

NPI assigned

Dec 28, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tiki Stafford

Title

Administrator

Phone

(904) 233-1090

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Diversity Me Doing business as

Tax ID family

Diversity Me2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Reffines House

  • Assisted Living Facility
  • Jacksonville, FL
  • NPI 1104332188
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1514419200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1514419200000",
    "number": "1225544208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3225 N MYRTLE AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322094231",
            "telephone_number": "904-233-1090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3225 N MYRTLE AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322094231",
            "telephone_number": "904-233-1090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIKI STAFFORD",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-28",
        "last_updated": "2017-12-28",
        "status": "A",
        "authorized_official_last_name": "STAFFORD",
        "authorized_official_first_name": "TIKI",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "904-233-1090"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL11951",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004414400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Diversity Me",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sara Beth Tierney, LCSW
• Vicki D Tierney, OTR, MHS
• Tiffany Baltiero LMT LLC
• Tiffany'S Homemaker and Companion
• Robin Shepherd Tighe, APRN
• Suwarna M Tilak, MD
• Grace Alexandra Tilbrook, AUD
• Ralph Thomas Tilbury, M.D.
• Beatrice Joy Tiller
• Bryce R Tiller, MD

• Assisted Living Facility in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.