MEDICARE: TIFFANY JEAN THOMAS

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	APRN11025985	FL

General Provider Information

NPI Number	:	1962085076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY JEAN THOMAS

Provider Business Mailing Address
First Line	:	950 S DILLARD ST
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-3912
Country	:	US
Telephone Number	:	407-514-1300
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 S DILLARD ST
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-3912
Country	:	US
Telephone Number	:	407-514-1300
Fax Number	:

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

Provider Enumeration Date	:	05/05/2021
Last Update Date	:	11/15/2023

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Directions to “ TIFFANY JEAN THOMAS ” Practice Location

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