Provider Demographics
NPI:1245967389
Name:MARTIN, TIFFANY (APRN)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Mailing Address - Street 1:508 S HABANA AVE STE 340
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4191
Mailing Address - Country:US
Mailing Address - Phone:813-873-7367
Mailing Address - Fax:813-875-9722
Practice Address - Street 1:508 S HABANA AVE STE 340
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4191
Practice Address - Country:US
Practice Address - Phone:813-873-7367
Practice Address - Fax:813-875-9722
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2024-12-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL11020622363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115162200Medicaid
FLUAE19OtherBLUE CROSS BLUE SHIELD