Provider Demographics
NPI:1558307421
Name:PADGETT, TIFFANEE ANN (ARNP)
Entity Type:Individual
Prefix:
First Name:TIFFANEE
Middle Name:ANN
Last Name:PADGETT
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 1:555 N BYRON BUTLER PKWY
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32347-2315
Mailing Address - Country:US
Mailing Address - Phone:850-223-5400
Mailing Address - Fax:850-223-5401
Practice Address - Street 1:555 N BYRON BUTLER PKWY
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:FL
Practice Address - Zip Code:32347-2315
Practice Address - Country:US
Practice Address - Phone:850-584-0600
Practice Address - Fax:850-584-0602
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3201862363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307441200Medicaid
FL4091JOtherBCBS
FLQ70941Medicare UPIN
FL478912Medicare PIN