MEDICARE: TIFFANY LONG VAN ARSDALE ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	2011013110	MO
2	363LF0000X	Family Nurse Practitioner	ARNP9236293	FL

General Provider Information

NPI Number	:	1407099351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY LONG VAN ARSDALE ARNP

Provider Business Mailing Address
First Line	:	4065 N LECANTO HWY
Second Line	:	SUITE 600
City	:	BEVERLY HILLS
State	:	FL
Zip	:	34465-3555
Country	:	US
Telephone Number	:	352-565-4300
Fax Number	:	352-270-8872

Provider Business Practice Location Address
First Line	:	4065 N LECANTO HWY
Second Line	:	SUITE 600
City	:	BEVERLY HILLS
State	:	FL
Zip	:	34465-3555
Country	:	US
Telephone Number	:	352-565-4300
Fax Number	:	352-270-8872

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2009
Last Update Date	:	09/09/2024

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