Healthcare Provider Details

I. General information

NPI: 1346824240
Provider Name (Legal Business Name): TIFFANY LYNN SMITH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13101 TELECOM DR STE 120
TEMPLE TERRACE FL
33637-0936
US

IV. Provider business mailing address

13101 TELECOM DR STE 120
TEMPLE TERRACE FL
33637-0936
US

V. Phone/Fax

Practice location:
  • Phone: 813-384-7855
  • Fax:
Mailing address:
  • Phone: 813-384-7855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9114350
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: