Healthcare Provider Details

I. General information

NPI: 1386476364
Provider Name (Legal Business Name): TIFFANY K NELSON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2024
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7109 NW 11TH PL STE C
GAINESVILLE FL
32605-3141
US

IV. Provider business mailing address

2460 OLD MOULTRIE RD STE 1
ST AUGUSTINE FL
32086-4198
US

V. Phone/Fax

Practice location:
  • Phone: 352-363-6478
  • Fax:
Mailing address:
  • Phone: 904-994-0006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11038941
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number9170697
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: