Provider Demographics
NPI:1235918012
Name:SULLIVAN, TIFFANY CAMILLE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:CAMILLE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:BARONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 15TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33570-3507
Mailing Address - Country:US
Mailing Address - Phone:813-508-1327
Mailing Address - Fax:
Practice Address - Street 1:503 EICHENFELD DR STE 104
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5984
Practice Address - Country:US
Practice Address - Phone:813-708-6107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9340933163WE0003X
FL11028986363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency