Provider Demographics
NPI:1750311122
Name:MONAHAN, TIFFANY KAY (OD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:KAY
Last Name:MONAHAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3564 SW ARCHER RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-2438
Mailing Address - Country:US
Mailing Address - Phone:352-371-0994
Mailing Address - Fax:
Practice Address - Street 1:3564 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-2438
Practice Address - Country:US
Practice Address - Phone:352-371-0994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3490152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL68151OtherBCBS
FL68151OtherBCBS