Healthcare Provider Details

I. General information

NPI: 1801410212
Provider Name (Legal Business Name): TIFFANY LYNN EISENBACH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2020
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2473 CARE DR STE 102
TALLAHASSEE FL
32308-9815
US

IV. Provider business mailing address

1515 SW ARCHER RD
GAINESVILLE FL
32608-1134
US

V. Phone/Fax

Practice location:
  • Phone: 850-431-5001
  • Fax:
Mailing address:
  • Phone: 352-265-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME168043
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: