Healthcare Provider Details

I. General information

NPI: 1497083042
Provider Name (Legal Business Name): TIFFANY L KOCHHEISER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2009
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 SE RIVERSIDE DR STE 203
STUART FL
34994-2579
US

IV. Provider business mailing address

901 45TH ST KIMMEL BLDG
WEST PALM BEACH FL
33407-2413
US

V. Phone/Fax

Practice location:
  • Phone: 772-288-5862
  • Fax: 772-288-5874
Mailing address:
  • Phone: 561-844-5255
  • Fax: 561-844-5245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9105258
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: