Provider Demographics
NPI:1154709384
Name:GREEN, TIFFANY H (MD)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:H
Last Name:GREEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9960 NW 116TH WAY STE 13
Mailing Address - Street 2:
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1175
Mailing Address - Country:US
Mailing Address - Phone:786-924-1311
Mailing Address - Fax:786-924-1313
Practice Address - Street 1:2901 RIGSBY LN STE G
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-4828
Practice Address - Country:US
Practice Address - Phone:727-287-1250
Practice Address - Fax:727-287-1270
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-07
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME1470632084N0400X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108062700Medicaid
FLM2341OtherMEDICARE