MEDICARE: TIFFANY JAMES APRN

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	APRN9482083	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	APRN9482083	OTHER	FL	STATE LICENSE

General Provider Information

NPI Number	:	1588089098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY JAMES APRN

Provider Business Mailing Address
First Line	:	1555 INDIAN RIVER BLVD STE B210
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-7113
Country	:	US
Telephone Number	:	772-257-8224
Fax Number	:	772-252-3245

Provider Business Practice Location Address
First Line	:	4680 LIPSCOMB ST NE STE 10B
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-2928
Country	:	US
Telephone Number	:	321-364-3758
Fax Number	:	833-635-8722

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

Provider Enumeration Date	:	02/20/2014
Last Update Date	:	02/12/2026

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