Healthcare Provider Details

I. General information

NPI: 1306263140
Provider Name (Legal Business Name): TIFFANY GAITHER ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2014
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-8459
US

IV. Provider business mailing address

PO BOX 100225
GAINESVILLE FL
32610-0225
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-8737
  • Fax: 352-273-8737
Mailing address:
  • Phone: 352-273-8737
  • Fax: 352-273-9154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9264352
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN9264352
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: