Provider Demographics
NPI:1942516885
Name:SHAFFER, THITIPORN LERTRATANAKUL (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:THITIPORN
Middle Name:LERTRATANAKUL
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 SW 92ND ST STE 204B
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7377
Mailing Address - Country:US
Mailing Address - Phone:305-928-7249
Mailing Address - Fax:305-630-3632
Practice Address - Street 1:8900 N KENDALL DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2197
Practice Address - Country:US
Practice Address - Phone:308-928-7249
Practice Address - Fax:305-630-3632
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2118932164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112888600Medicaid
FLARNP2118932OtherLICENSE NO.