Individual ProviderTiffany BlacklidgeStudent in an Organized Health Care Education/Training ProgramStudent, Health CarePractice Address19555 N 59th Ave, Glendale, AZ 85308-6813(623) 572-3200PECOS EnrollmentBased on the most recent information from CMS, provider Tiffany Blacklidge does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 8 days ago.Profile DetailsProvider ID1235959511Provider TypeIndividualFull NameBlacklidge, TiffanyGenderFemaleSole ProprietorNoEnumeration Date10/11/2024Last Updated10/11/2024Contact InformationPractice LocationPractice Address19555 N 59th Ave, Glendale, AZ 85308-6813Phone(623) 572-3200FaxUnlisted FaxMailing LocationMailing Address10525 Major Ave Apt 1n, Chicago Ridge, IL 60415-2046PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode390200000XPrimaryDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer