Provider Demographics
NPI:1679137541
Name:SMILEY, TIFFANY (FNP-C)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:SMILEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13438 FORT KING RD
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-5214
Mailing Address - Country:US
Mailing Address - Phone:352-567-5266
Mailing Address - Fax:352-567-3066
Practice Address - Street 1:3000 MEDICAL PARK DR STE 490
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-6600
Practice Address - Country:US
Practice Address - Phone:813-971-2470
Practice Address - Fax:813-971-2491
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-26
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11000328363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily