Healthcare Provider Details

I. General information

NPI: 1720919582
Provider Name (Legal Business Name): TIFFANY FEASBY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5702 SHIVER TRL
PLANT CITY FL
33565-4302
US

IV. Provider business mailing address

5702 SHIVER TRL
PLANT CITY FL
33565-4302
US

V. Phone/Fax

Practice location:
  • Phone: 813-407-1472
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN11047799
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11047799
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: