=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376902585
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TIFFANY STEPHENS FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2016
-----------------------------------------------------
Last Update Date | 10/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 601 E ROLLINS ST PEDIATRIC INTENSIVISTS
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32803-1248
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-975-0410
-----------------------------------------------------
Fax | 407-975-0411
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2501 N ORANGE AVE STE 446
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32804-4644
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-975-0410
-----------------------------------------------------
Fax | 407-975-0411
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0222X
-----------------------------------------------------
Taxonomy Name | Critical Care Pediatric Nurse Practitioner
-----------------------------------------------------
License Number | ARNP9242343
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------