Provider Demographics
NPI:1790189033
Name:DARNOLD, TIFFANY MARIE (PA)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:MARIE
Last Name:DARNOLD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 WOODBURY RD
Mailing Address - Street 2:SUITE104
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-4515
Mailing Address - Country:US
Mailing Address - Phone:407-282-3344
Mailing Address - Fax:
Practice Address - Street 1:815 WOODBURY RD
Practice Address - Street 2:SUITE104
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-4515
Practice Address - Country:US
Practice Address - Phone:407-282-3344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-15
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108284363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical