MEDICARE: TIFFANY NICOLE COLVIN PA

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	363AM0700X	Medical Physician Assistant	PA9104910	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1085909	OTHER		NCCPA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972741692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY NICOLE COLVIN PA

Provider Business Mailing Address
First Line	:	7016 NORMANDY BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32205-6206
Country	:	US
Telephone Number	:	904-783-9428
Fax Number	:	904-786-4981

Provider Business Practice Location Address
First Line	:	7016 NORMANDY BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32205-6206
Country	:	US
Telephone Number	:	904-783-9428
Fax Number	:	904-786-4981

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

Provider Enumeration Date	:	02/03/2009
Last Update Date	:	01/28/2020

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Directions to “ TIFFANY NICOLE COLVIN PA” Practice Location

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