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General NPI Number Information
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NPI Number | 1710787023
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Entity Type | Individual
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Provider Name | TIFFANY SHAWNAKAY COSTLEY ARNP
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Gender | Female
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Dates
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Enumeration Date | 03/17/2025
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Last Update Date | 06/29/2025
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Provider Practice Location Address
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Address Line | 5340 N FEDERAL HWY STE 110
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City | LIGHTHOUSE POINT
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State | FL
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Zip | 33064-7058
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Country | US
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Telephone | 347-777-7997
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Fax |
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Provider Business Mailing Address
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Address Line | 7534 PINEWALK DR S
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City | MARGATE
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State | FL
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Zip | 33063-8120
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Country | US
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Telephone |
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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 | 11037915
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License Number State | FL
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