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General NPI Number Information
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NPI Number | 1164822649
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Entity Type | Individual
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Provider Name | TIFFANY RENEE COMERIE PA
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Gender | Female
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Dates
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Enumeration Date | 09/03/2014
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Last Update Date | 09/18/2014
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Provider Practice Location Address
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Address Line | 5000 W OAKLAND PARK BLVD
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33313-1503
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Country | US
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Telephone | 954-263-7262
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Fax |
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Provider Business Mailing Address
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Address Line | 6122 GRAND CYPRESS CIR E
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City | COCONUT CREEK
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State | FL
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Zip | 33073-2343
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Country | US
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Telephone | 954-263-7262
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9108164
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License Number State | FL
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