Healthcare Provider Details

I. General information

NPI: 1548615073
Provider Name (Legal Business Name): TIFFANY YELTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TIFFANY YELTON PMHNP-BC

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12457 TAMIAMI TRL S UNIT 4
NORTH PORT FL
34287-1455
US

IV. Provider business mailing address

4310 METRO PKWY STE 205
FORT MYERS FL
33916-9416
US

V. Phone/Fax

Practice location:
  • Phone: 816-337-7862
  • Fax:
Mailing address:
  • Phone: 239-223-2751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number2016012517
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2016012517
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11006884
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: