Healthcare Provider Details

I. General information

NPI: 1174337356
Provider Name (Legal Business Name): TIFFANY NICOLE MCDONALD PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 OAKFIELD DR STE 205
BRANDON FL
33511-0827
US

IV. Provider business mailing address

1602 OAKFIELD DR STE 205
BRANDON FL
33511-0827
US

V. Phone/Fax

Practice location:
  • Phone: 813-655-6367
  • Fax:
Mailing address:
  • Phone: 813-655-6367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11037575
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: