Provider Demographics
NPI:1760862585
Name:WINK, TIFFANY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:WINK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:BRADFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1845 TOWN CENTER BLVD
Mailing Address - Street 2:#410
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-3356
Mailing Address - Country:US
Mailing Address - Phone:904-621-0396
Mailing Address - Fax:904-621-0397
Practice Address - Street 1:1845 TOWN CENTER BLVD
Practice Address - Street 2:#410
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-3356
Practice Address - Country:US
Practice Address - Phone:904-621-0396
Practice Address - Fax:904-621-0397
Is Sole Proprietor?:No
Enumeration Date:2015-06-06
Last Update Date:2015-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 30377225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist