Provider Demographics
NPI:1790071835
Name:BURCA, TIFFANY R (DO)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:R
Last Name:BURCA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35095 US HIGHWAY 19 N STE 100
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-1968
Mailing Address - Country:US
Mailing Address - Phone:727-953-8404
Mailing Address - Fax:813-635-7866
Practice Address - Street 1:35095 US HIGHWAY 19 N STE 100
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-1968
Practice Address - Country:US
Practice Address - Phone:727-953-8404
Practice Address - Fax:813-635-7866
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0059991207Q00000X, 207Q00000X
FLOS16999207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO028853OtherKAISER COMMERCIAL NUMBER
CO9000155034Medicaid
FLPENDINGMedicaid