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General NPI Number Information
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NPI Number | 1457005340
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Entity Type | Individual
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Provider Name | TIFFANY MARIN
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Gender | Female
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Dates
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Enumeration Date | 02/09/2022
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Last Update Date | 02/09/2022
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Provider Practice Location Address
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Address Line | 2100 NW 42 AVE
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City | MIAMI
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State | FL
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Zip | 33142
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Country | US
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Telephone | 786-591-2767
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Fax |
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Provider Business Mailing Address
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Address Line | 25000 SW 197TH AVE
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City | HOMESTEAD
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State | FL
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Zip | 33031-1642
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Country | US
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Telephone | 786-218-8231
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11017763
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License Number State | FL
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