MEDICARE: TIFFANY LEANNA FARRIS

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	APRN11046512	FL

General Provider Information

NPI Number	:	1477494474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY LEANNA FARRIS

Provider Business Mailing Address
First Line	:	103 BONAIRE DR
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32413-6006
Country	:	US
Telephone Number	:	850-818-8244
Fax Number	:	949-909-1814

Provider Business Practice Location Address
First Line	:	2195 JENKS AVE STE B
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4683
Country	:	US
Telephone Number	:	850-774-8484
Fax Number	:

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

Provider Enumeration Date	:	04/03/2026
Last Update Date	:	06/08/2026

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Directions to “ TIFFANY LEANNA FARRIS ” Practice Location

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