Healthcare Provider Details

I. General information

NPI: 1497131593
Provider Name (Legal Business Name): TIFFANY TYNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2015
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30327 PONGO WAY
WESLEY CHAPEL FL
33545
US

IV. Provider business mailing address

30327 PONGO WAY
WESLEY CHAPEL FL
33545-1347
US

V. Phone/Fax

Practice location:
  • Phone: 813-977-8700
  • Fax: 813-971-2029
Mailing address:
  • Phone: 813-977-8700
  • Fax: 813-971-2029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: