Healthcare Provider Details

I. General information

NPI: 1952248635
Provider Name (Legal Business Name): TIFFANY BEECH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 PRIM AVE STE 20
GRACEVILLE FL
32440-2500
US

IV. Provider business mailing address

951 PRIM AVE STE 20
GRACEVILLE FL
32440-2500
US

V. Phone/Fax

Practice location:
  • Phone: 850-360-4000
  • Fax:
Mailing address:
  • Phone: 850-360-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11047181
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: