MEDICARE: MS. TIFFANY N POYNTER ATC, LAT

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	2255A2300X	Athletic Trainer	AL 3488	FL

General Provider Information

NPI Number	:	1447685193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TIFFANY N POYNTER ATC, LAT

Provider Business Mailing Address
First Line	:	1798 CUNNINGHAM ESTATES RD
Second Line	:
City	:	SAINT JOHNS
State	:	FL
Zip	:	32259-2975
Country	:	US
Telephone Number	:	904-378-6907
Fax Number	:

Provider Business Practice Location Address
First Line	:	5530 FIRESTONE RD
Second Line	:	SUITE 201
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-1530
Country	:	US
Telephone Number	:	904-436-8571
Fax Number	:

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

Provider Enumeration Date	:	09/12/2013
Last Update Date	:	09/26/2016

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