Provider Demographics
NPI:1639301070
Name:BURGESS, TIFFANIE SHAY (APRN)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANIE
Middle Name:SHAY
Last Name:BURGESS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TIFFANIE
Other - Middle Name:SHAY
Other - Last Name:BASILE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:7995 66TH STREET N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781
Mailing Address - Country:US
Mailing Address - Phone:727-530-0920
Mailing Address - Fax:727-849-0931
Practice Address - Street 1:7995 66TH STREET N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781
Practice Address - Country:US
Practice Address - Phone:727-530-0920
Practice Address - Fax:727-849-0931
Is Sole Proprietor?:No
Enumeration Date:2009-08-19
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9178406363L00000X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9178406OtherLICENSE