Healthcare Provider Details

I. General information

NPI: 1366264400
Provider Name (Legal Business Name): TIFFANY CAITLIN KELLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIFFANY BYRD

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10251 SORRENTO RD
PENSACOLA FL
32507-8603
US

IV. Provider business mailing address

1500 1ST AVE N UNIT 3
BIRMINGHAM AL
35203-1866
US

V. Phone/Fax

Practice location:
  • Phone: 850-941-7547
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN9652092
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: