MEDICARE: TIFFANY LAUREN WRIGHT FNP-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	163W00000X	Registered Nurse	9564961	FL
2	363LF0000X	Family Nurse Practitioner	25285	TN
3	363LF0000X	Family Nurse Practitioner	11010595	FL

General Provider Information

NPI Number	:	1447818190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY LAUREN WRIGHT FNP-C

Provider Business Mailing Address
First Line	:	3235 USHANT CT
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33414-7437
Country	:	US
Telephone Number	:	662-322-0541
Fax Number	:

Provider Business Practice Location Address
First Line	:	4500 FL-7
Second Line	:	SUITE 102
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33319-3331
Country	:	US
Telephone Number	:	561-476-0060
Fax Number	:

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

Provider Enumeration Date	:	05/29/2019
Last Update Date	:	10/13/2021

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