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NPI Code Detail

MEDICARE: TIFFANY CHIN LAU ARNP

MEDICARE: TIFFANY CHIN LAU ARNP
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
1363LF0000XFamily Nurse Practitioner9246827FL

General Provider Information

NPI Number : 1083928378
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANY CHIN LAU ARNP
Provider Business Mailing Address
First Line : 6734 BRIDGEWATER VILLAGE RD
Second Line :
City : WINDERMERE
State : FL
Zip : 34786-7386
Country : US
Telephone Number : 866-389-2727
Fax Number :
Provider Business Practice Location Address
First Line : 4280 SOUTHSIDE BLVD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-5400
Country : US
Telephone Number : 866-389-2727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2010
Last Update Date : 10/05/2016

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