MEDICARE: MISS TIFFANY NICOLE MICHAUX 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	363LG0600X	Gerontology Nurse Practitioner	APRN9247370	FL
2	363LF0000X	Family Nurse Practitioner	ARNP9247370	FL

General Provider Information

NPI Number	:	1629448337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS TIFFANY NICOLE MICHAUX ARNP

Provider Business Mailing Address
First Line	:	5200 BABCOCK ST NE STE 101
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-4639
Country	:	US
Telephone Number	:	407-716-8528
Fax Number	:	407-716-8528

Provider Business Practice Location Address
First Line	:	5200 BABCOCK ST NE STE 101
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-4639
Country	:	US
Telephone Number	:	407-716-8528
Fax Number	:	407-716-8528

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

Provider Enumeration Date	:	10/07/2015
Last Update Date	:	01/02/2025

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