MEDICARE: TIFFANY ARNOLD MARTIN APRN-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	APRN11030373	FL
2	207Q00000X	Family Medicine Physician	APRN11030373	FL

General Provider Information

NPI Number	:	1073382313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY ARNOLD MARTIN APRN-C

Provider Business Mailing Address
First Line	:	116 LAKEVIEW TER
Second Line	:
City	:	LYNN HAVEN
State	:	FL
Zip	:	32444-4931
Country	:	US
Telephone Number	:	864-723-6990
Fax Number	:

Provider Business Practice Location Address
First Line	:	12111 PANAMA CITY BEACH PKWY
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407-2609
Country	:	US
Telephone Number	:	850-588-1066
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2023
Last Update Date	:	05/15/2026

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