Healthcare Provider Details

I. General information

NPI: 1184042921
Provider Name (Legal Business Name): TIFFANY JARRETT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2014
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 45TH ST
MANGONIA PARK FL
33407-2413
US

IV. Provider business mailing address

6871 PEACHTREE DUNWOODY RD APT 342
ATLANTA GA
30328-5740
US

V. Phone/Fax

Practice location:
  • Phone: 561-882-4541
  • Fax: 561-650-6093
Mailing address:
  • Phone: 954-918-1799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME139558
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME139558
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: