MEDICARE: TIFFANY MEDINA

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	103K00000X	Behavior Analyst	1-25-79061	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174063689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY MEDINA

Provider Business Mailing Address
First Line	:	626 N ALAFAYA TRL STE 206
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-4353
Country	:	US
Telephone Number	:	689-326-7019
Fax Number	:

Provider Business Practice Location Address
First Line	:	626 N ALAFAYA TRL STE 206
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-4353
Country	:	US
Telephone Number	:	689-326-7019
Fax Number	:

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

Provider Enumeration Date	:	03/02/2017
Last Update Date	:	10/13/2025

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Directions to “ TIFFANY MEDINA ” Practice Location

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