Healthcare Provider Details

I. General information

NPI: 1003366949
Provider Name (Legal Business Name): TIFFANY KRISTINE LAMARCA FNP-BC, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2016
Last Update Date: 08/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2061 ENGLEWOOD RD STE 5
ENGLEWOOD FL
34223
US

IV. Provider business mailing address

2061 ENGLEWOOD RD STE 5
ENGLEWOOD FL
34223-1749
US

V. Phone/Fax

Practice location:
  • Phone: 941-473-8881
  • Fax: 941-475-0801
Mailing address:
  • Phone: 941-473-8881
  • Fax: 941-475-0801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9411338
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: