Provider Demographics
NPI:1407529928
Name:FALCON, TIFFANY (FNP-C APRN)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:FALCON
Suffix:
Gender:F
Credentials:FNP-C APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3404 MIDDLEBROOK PL
Mailing Address - Street 2:
Mailing Address - City:HARMONY
Mailing Address - State:FL
Mailing Address - Zip Code:34773-6056
Mailing Address - Country:US
Mailing Address - Phone:407-818-6632
Mailing Address - Fax:
Practice Address - Street 1:2450 N ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-2316
Practice Address - Country:US
Practice Address - Phone:407-846-4343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11014595363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11014595OtherFLORIDA BOARD OF NURSING APRN