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General NPI Number Information
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NPI Number | 1851657241
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Entity Type | Individual
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Provider Name | TIFFANY JEANNE-MILLS WIMSATT PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/10/2012
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Last Update Date | 03/04/2026
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Provider Practice Location Address
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Address Line | 201A LONGWOOD DR SE
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City | HUNTSVILLE
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State | AL
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Zip | 35801-2742
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Country | US
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Telephone | 850-233-3376
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Fax | 850-522-8354
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Provider Business Mailing Address
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Address Line | 2505 HARRISON AVE
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City | PANAMA CITY
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State | FL
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Zip | 32405-4464
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Country | US
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Telephone | 850-233-3376
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Fax | 850-522-8354
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0010-03282
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 56953
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA-1193
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License Number State | AL
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