MEDICARE: TIFFANY BURR

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	174400000X	Specialist

General Provider Information

NPI Number	:	1689454456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY BURR

Provider Business Mailing Address
First Line	:	12220 ATLANTIC BLVD STE 130
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-5826
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1250 BROOKWOOD FOREST BLVD APT 5208
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-9068
Country	:	US
Telephone Number	:	904-258-7213
Fax Number	:

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

Provider Enumeration Date	:	09/29/2023
Last Update Date	:	09/29/2023

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Directions to “ TIFFANY BURR ” Practice Location

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