Healthcare Provider Details

I. General information

NPI: 1407529928
Provider Name (Legal Business Name): TIFFANY FALCON FNP-C APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 N ORANGE BLOSSOM TRL
KISSIMMEE FL
34744-2316
US

IV. Provider business mailing address

3404 MIDDLEBROOK PL
HARMONY FL
34773-6056
US

V. Phone/Fax

Practice location:
  • Phone: 407-846-4343
  • Fax:
Mailing address:
  • Phone: 407-818-6632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11014595
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: