Healthcare Provider Details

I. General information

NPI: 1063347748
Provider Name (Legal Business Name): TIFFANY LYNN KING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E JACKSON ST STE 3300
TAMPA FL
33602-5228
US

IV. Provider business mailing address

401 E JACKSON ST STE 3300
TAMPA FL
33602-5228
US

V. Phone/Fax

Practice location:
  • Phone: 866-277-3679
  • Fax:
Mailing address:
  • Phone: 866-277-3679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE101266
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: