Provider Demographics
NPI:1295981066
Name:KRUGER, TIFFANY LEE (DO)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LEE
Last Name:KRUGER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:LEE
Other - Last Name:GOMILLION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:4100 S FERDON BLVD STE C2
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-5287
Mailing Address - Country:US
Mailing Address - Phone:850-683-3937
Mailing Address - Fax:850-683-0227
Practice Address - Street 1:4100 S FERDON BLVD STE C2
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-5287
Practice Address - Country:US
Practice Address - Phone:850-683-3937
Practice Address - Fax:850-683-0227
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10815207W00000X, 207WX0110X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology