Healthcare Provider Details

I. General information

NPI: 1447352380
Provider Name (Legal Business Name): TIFFANY P POTTER AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5881 RAND BLVD
SARASOTA FL
34238-5115
US

IV. Provider business mailing address

2732 COVENTRY DR
SARASOTA FL
34231-6922
US

V. Phone/Fax

Practice location:
  • Phone: 941-927-8805
  • Fax:
Mailing address:
  • Phone: 941-923-6408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY1376
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: