Provider Demographics
NPI:1518445667
Name:CONNORS, TIFFANY MERCEDES (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:MERCEDES
Last Name:CONNORS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7015 A C SKINNER PKWY STE 1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6932
Mailing Address - Country:US
Mailing Address - Phone:904-363-2113
Mailing Address - Fax:904-363-2606
Practice Address - Street 1:14546 OLD SAINT AUGUSTINE RD STE 317
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5472
Practice Address - Country:US
Practice Address - Phone:904-260-9445
Practice Address - Fax:904-260-0005
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9281020363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115804500Medicaid
FL8M6RYOtherFL BLUE
FLPO094OtherMEDICARE