Provider Demographics
NPI:1629448337
Name:MICHAUX, TIFFANY NICOLE (ARNP)
Entity Type:Individual
Prefix:MISS
First Name:TIFFANY
Middle Name:NICOLE
Last Name:MICHAUX
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 1:720 E NEW HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-5474
Mailing Address - Country:US
Mailing Address - Phone:321-499-3290
Mailing Address - Fax:321-499-3289
Practice Address - Street 1:720 E NEW HAVEN AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-5474
Practice Address - Country:US
Practice Address - Phone:321-499-3290
Practice Address - Fax:321-499-3289
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9247370363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily