Provider Demographics
NPI:1093033664
Name:BLOCKSON, TIFFANY L (MD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:L
Last Name:BLOCKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14015 EGRET TOWER DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-6197
Mailing Address - Country:US
Mailing Address - Phone:407-447-7100
Mailing Address - Fax:407-447-6100
Practice Address - Street 1:14015 EGRET TOWER DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-6197
Practice Address - Country:US
Practice Address - Phone:407-447-7100
Practice Address - Fax:407-447-6100
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL107095208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics