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NPI Code Detail

MEDICARE: TIFFANY KNIGHTLY

MEDICARE: TIFFANY KNIGHTLY
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
1363LX0001XObstetrics & Gynecology Nurse PractitionerARNP9255196FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1922310515
Entity Type Code : Organization
Provider Name (Legal Business Name) : TIFFANY KNIGHTLY
Provider Business Mailing Address
First Line : PO BOX 748817
Second Line :
City : ATLANTA
State : GA
Zip : 30374-8817
Country : US
Telephone Number : 181-328-6003
Fax Number : 813-282-1806
Provider Business Practice Location Address
First Line : 2400 HOOKS ST
Second Line :
City : CLERMONT
State : FL
Zip : 34711-3514
Country : US
Telephone Number : 352-241-6460
Fax Number : 352-241-6461
Authorized Official
Title or Position : COO
Name : ELLEN MICHELLE BOWER
Credential :
Telephone Number : 813-286-2033
Provider Enumeration Date : 07/12/2010
Last Update Date : 05/10/2023

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1043320021 — DR. RAYMOND IGLECIA - FERNANDEZ MD
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1275598815 — MRS. CYNTHIA M PERKINS CNM
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Directions to “TIFFANY KNIGHTLY ” Practice Location

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