Healthcare Provider Details

I. General information

NPI: 1306451521
Provider Name (Legal Business Name): TIFFANY NICOLE JARAMILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 W SUNRISE BLVD
PLANTATION FL
33322-4113
US

IV. Provider business mailing address

11800 NW 14TH CT
PEMBROKE PINES FL
33026-2580
US

V. Phone/Fax

Practice location:
  • Phone: 800-437-2672
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA611
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: