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General NPI Number Information
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NPI Number | 1720537343
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Entity Type | Individual
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Provider Name | TIFFANY GAIL MINNIS NP-C
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Gender | Female
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Dates
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Enumeration Date | 09/23/2016
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Last Update Date | 02/22/2017
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Provider Practice Location Address
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Address Line | 693 SW PORT ST LUCIE BLVD
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34953-1998
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Country | US
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Telephone | 772-398-6200
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Fax |
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Provider Business Mailing Address
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Address Line | 4131 WORLINGTON TERRACE
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City | FORT PIERCE
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State | FL
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Zip | 34947
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Country | US
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Telephone | 772-882-0687
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | F0916653
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License Number State | FL
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