MEDICARE: TIFFANY MARIE LOCK 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	363LG0600X	Gerontology Nurse Practitioner	APRN11015090	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	:	1639846454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY MARIE LOCK APRN

Provider Business Mailing Address
First Line	:	804 EMMETT ST
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-5434
Country	:	US
Telephone Number	:	407-785-1111
Fax Number	:	407-553-3061

Provider Business Practice Location Address
First Line	:	804 EMMETT ST
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-5434
Country	:	US
Telephone Number	:	407-785-1111
Fax Number	:	407-553-3061

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

Provider Enumeration Date	:	08/28/2021
Last Update Date	:	06/23/2026

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Directions to “ TIFFANY MARIE LOCK APRN” Practice Location

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