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General NPI Number Information
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NPI Number | 1194501585
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Entity Type | Individual
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Provider Name | TIFFANY FERNANDEZ
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Gender | Female
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Dates
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Enumeration Date | 09/01/2023
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Last Update Date | 09/01/2023
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Provider Practice Location Address
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Address Line | 5165 ADANSON ST
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City | ORLANDO
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State | FL
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Zip | 32804-1331
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Country | US
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Telephone | 516-606-6810
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Fax |
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Provider Business Mailing Address
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Address Line | 11305 SUMMER WIND CT
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City | CLERMONT
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State | FL
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Zip | 34711-5032
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Country | US
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Telephone | 516-606-6810
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA31115
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License Number State | FL
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