MEDICARE: TIFFANY DAVIS APRN

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	363LF0000X	Family Nurse Practitioner	APRN11038344	FL

General Provider Information

NPI Number	:	1083507446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY DAVIS APRN

Provider Business Mailing Address
First Line	:	5274 MONTEJO DR
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32305-2407
Country	:	US
Telephone Number	:	850-321-2067
Fax Number	:

Provider Business Practice Location Address
First Line	:	817 NW 56TH TER STE B
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32605-6401
Country	:	US
Telephone Number	:	352-234-3050
Fax Number	:

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

Provider Enumeration Date	:	06/02/2025
Last Update Date	:	06/02/2025

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