Healthcare Provider Details

I. General information

NPI: 1285533943
Provider Name (Legal Business Name): AUTUMN LEE TIPPS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2026
Last Update Date: 11/02/2026
Certification Date: 10/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5721 USA N DR
MOBILE AL
36688-0001
US

IV. Provider business mailing address

3081 ORANGE PICKER RD
JACKSONVILLE FL
32223-0882
US

V. Phone/Fax

Practice location:
  • Phone: 251-445-9400
  • Fax:
Mailing address:
  • Phone: 682-561-3469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number944850
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: