Provider Demographics
NPI:1245604594
Name:JAMES, TIFFANY DAWN HAULK (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:DAWN HAULK
Last Name:JAMES
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7960 SW 60TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476-6457
Mailing Address - Country:US
Mailing Address - Phone:352-671-6741
Mailing Address - Fax:352-671-6742
Practice Address - Street 1:7960 SW 60TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-6457
Practice Address - Country:US
Practice Address - Phone:352-671-6741
Practice Address - Fax:352-671-6742
Is Sole Proprietor?:No
Enumeration Date:2015-11-24
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9421200363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics