Healthcare Provider Details

I. General information

NPI: 1306651807
Provider Name (Legal Business Name): TIFFANY MARIE TEJEDOR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11151 SPRING HILL DR
SPRING HILL FL
34609-4649
US

IV. Provider business mailing address

13402 SW 269TH ST
HOMESTEAD FL
33032-7768
US

V. Phone/Fax

Practice location:
  • Phone: 352-701-4030
  • Fax:
Mailing address:
  • Phone: 305-978-7195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2024088110
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: