Healthcare Provider Details

I. General information

NPI: 1710747308
Provider Name (Legal Business Name): TIFFANY MARIE SUMNER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4980 TAMIAMI TRL N SUITE 102
NAPLES FL
34103
US

IV. Provider business mailing address

1525 21ST ST SW
NAPLES FL
34117-4339
US

V. Phone/Fax

Practice location:
  • Phone: 239-649-2300
  • Fax:
Mailing address:
  • Phone: 239-207-8490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11031420
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: