Provider Demographics
NPI:1821405911
Name:RADNEY, TIFFANIE DIANE (ARNP-C)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANIE
Middle Name:DIANE
Last Name:RADNEY
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 PATTERSON RD
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-6247
Mailing Address - Country:US
Mailing Address - Phone:863-422-4338
Mailing Address - Fax:863-422-3736
Practice Address - Street 1:295 PATTERSON RD
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-6247
Practice Address - Country:US
Practice Address - Phone:863-422-4338
Practice Address - Fax:863-422-3736
Is Sole Proprietor?:No
Enumeration Date:2014-07-21
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9235190363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013020400Medicaid
FLHX391ZMedicare PIN